Medicaid Prior Authorization
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 Envolve Vision Services
Dental services need to be verified by DentaQuest
Behavioral Health/Substance Abuse need to be verified by Cenpatico
(Effective November 1, 2017, prior authorization for behavioral health will transition to Superior HealthPlan.)
*Please note, Incontinence Supplies ordered through the preferred DME provider do not require prior authorization.
Would this be for Family Planning services billed with a contraceptive management diagnosis?
|Types of Services||YES||NO|
|Are services being provided by a non-participating provider?|
|Is the member being admitted to an inpatient facility?|
|Are anesthesia services being rendered for dental procedures?|
|Is the member receiving oral surgery services?|
|Is the member receiving plastic and reconstructive surgeon services?|
|Is the member having chiropractic services?|
|Is the member receiving podiatry services?|