Medicare Pre-Auth

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DISCLAIMER:

All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. For specific details, please refer to the provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.

Vision Services need to be verified by Premier Eye Care
Dental Services need to be verified by DentaQuest
Hearing Services need to be verified by HearUSA

Non-participating providers must submit Prior Authorization for all services. For non-participating providers, Join Our Network.

Are Services being performed in the Emergency Department or Urgent Care Center, or are the services for dialysis or Hospice?

Yes No

Types of Services	YES	NO
Is the member being admitted to an inpatient facility?	serviceQuestion-0	serviceQuestion-0
Are anesthesia services being rendered for pain management or services in the office rendered by a non-participating provider?	serviceQuestion-1	serviceQuestion-1
Is this an Out of Network service request?	serviceQuestion-2	serviceQuestion-2

Medicare Pre-Auth

Are Services being performed in the Emergency Department or Urgent Care Center, or are the services for dialysis or Hospice?

YES - Services being performed in the Emergency Department or Urgent Care Center or Family Planning services billed with a Contraceptive Management diagnosis do NOT require prior authorization

Enter the code of the service you would like to check:

To submit a prior authorization Login Here.