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Medicaid Prior Authorization

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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.

Are Services being performed in the Emergency Department or Urgent Care Center or Family Planning services billed with a Contraceptive Management diagnosis?

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Is the member having an observation stay?
Are anesthesia services being rendered for dental procedures or pain management?
Are oral surgery services being provided in the office?
Are services, other than DME, orthotics, prosthetics, and supplies, being rendered in the home?
Is the member receiving hospice services?