Pre-Auth Needed?

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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 Opticare.
Dental Services need to be verified by Dental Health and Wellness.
Biopharmacy and Vaccines are carved out to MO HealthNet.
Behavioral Health/Substance Abuse need to be verified by Cenpatico.

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

Important Information for Out of Network Providers

Are Services being performed in the Emergency Department or Urgent Care Center, Public Health or Public Welfare Agency, 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 observation services?
Are anesthesia services being rendered for pain management?
Are services for a facility billing with Dental Diagnosis?
Are oral surgery services being provided in the office?
Is the member receiving hospice services?
Are services, other than DME, orthotics, prosthetics, and supplies, being rendered in the home?