Medicare Pre-Auth
SYSTEM UPDATES FOR 2019 CHANGES ARE UNDER CONSTRUCTION
All attempts are made to provide the most current information on the Pre-Auth Needed Tool. A prior authorization is not a guarantee of payment. Payment may be denied in accordance with Plan’s policies and procedures and applicable law. 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.
Dental Services are handled by Your Dental Plan.
Vision Services are handled by EyeMed.
High Tech Imaging services are handled by NIA.
Radiation Therapy and Sleep Studies are handled by Evicore.
Behavioral Health services are handled by MHN.
Acupuncture or Chiropractic services are handled by ASH.
All Out of Network requests require prior authorization except emergency care, out-of area urgent care or out-of-area dialysis.
Are services being performed in the Emergency Department, Urgent Care, Emergent Transportation, Dialysis, or for Hospice?
| Types of Services | YES | NO |
|---|---|---|
| IS THE MEMBER BEING ADMITTED TO AN INPATIENT FACILITY? | ||
| IS THE MEMBER HAVING GENDER REASSIGNMENT SERVICES? | ||
| ARE ANESTHESIA SERVICES BEING REQUIRED FOR PAIN MANAGEMENT OR SERVICES IN THE OFFICE RENDERED BY A NON-PARTICIPATING PROVIDER? | ||
| ARE SERVICES OTHER THAN LAB, RADIOLOGY, DOMICILIARY VISITS OR DME BEING RENDERED IN THE HOME? |