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Medicaid Pre-Auth

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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 (pdf). If you are uncertain that prior authorization is needed, please submit a request for an accurate response.

ATTENTION: Prior Authorization Requests should be submitted via our secure provider web portal.  To submit a prior authorization Login Here. Copies of all supporting clinical information are required for prior authorizations. Lack of clinical information may result in delayed determination or an adverse determination.

 

Additional information on Medicaid Exceptions (form) (PDF).

 

 

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?
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?

 

 

SERVICES BY VENDOR:

CENTENE SERVICES:

 

TURNING POINT: (ph: 1-855-777-7940,  fax: 1-573-469-4352)

  • Ear, Nose & Throat
  • Cardiac Services

 

EVOLENT: (formerly New Century Health / NIA)

  • Complex Imaging, CT scan, PET, MRA, MRI and high tech radiology procedures
  • Musculoskeletal Services
  • Outpatient Physical, Occupational and Speech Therapy Services

 

HOME STATE HEALTH: 1-855-694-HOME (4663), TTY 711

  • Alternative Therapy for Chronic Pain > age 21
  • Outpatient Physical, Occupational and Speech Therapy Services for Pregnant Women > age 21
  • Behavior Health/Substance Abuse - The Home State Health Behavioral Health UM and Customer Service staff can be reached directly at 1-866-864-1459
  • Sleep Study Services 

 

MO HEALTHNET:

  • Biopharmacy
  • Vaccines

        ***

» 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.*