Medicaid Pre-Auth
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.
Dental Services need to be verified by Envolve Dental.
Biopharmacy and Vaccines are carved out to MO HealthNet.
Behavior Health/Substance Abuse prior authorization request and questions, please call 1-866-864-1459.
Outpatient Physical, Occupational and Speech Therapy Services for members under age 21, need to be verified by NIA.
Complex Imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA
Musculoskeletal Services need to be verified by Turning Point
Non-participating providers must submit Prior Authorization for all services.
For non-participating providers, Join Our Network.
Important Information for Out of Network Providers (PDF)
*There may be age restrictions for DME and therapy services. It is important that you check the provider manual located on the MO Health Net website to confirm coverage. Prior authorization does not guarantee payment.*
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? | ||
| Are services, other than DME, orthotics, prosthetics, and supplies, being rendered in the home? |
*There may be age restrictions for DME and therapy services. It is important that you check the provider manual located on the MO Health Net website to confirm coverage. Prior authorization does not guarantee payment.*
ATTENTION: Copies of all supporting clinical information are required for prior authorizations. Lack of clinical information may result in delayed determination or a denial. To submit a prior authorization Login Here.