Medicare Pre-Auth

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.

Dental Services are handled by Your Dental Plan.

Vision Services are handled by Premiere Eye Care

Radiation Therapy and Sleep Studies are handled by Evicore.

Acupuncture or Chiropractic services are handled by ASH.

Prior Authorization at a Glance

Prior Authorization is NOT Required

The following services do NOT require prior authorization:

Services rendered in an emergency room or urgent care center
Services rendered by a public health or welfare agency
Family planning services billed with a contraceptive management diagnosis

Prior Authorization IS Required

The following services REQUIRE prior authorization:

Services rendered by an out out-of-network provider, with the exception of emergency and urgent care services
Admission of a member to an inpatient facility
Hospice services
Anesthesia services for pain management or dental procedures.
Services rendered at home, other than DME, orthotics, prosthetics, supplies and therapeutic injections
Services rendered by a chiropractor

Prior Authorization Check

Required Field

Enter Service Code

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