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

Vision Services need to be verified with Premier Eye Care.
For Dental in Texas, please verify with Liberty Dental.
For Dental in all other states, please verify with DentaQuest.

Complex imaging, MRA, MRI, PET, and CT scans MSK, IPM and Cardiac need to be verified by Evolent.

 

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

Are Services being performed in the Emergency Department or Urgent Care Center, or are the services for dialysis or Hospice?

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Are anesthesia services being rendered for pain management or services in the office rendered by a non-participating provider?
Is the member receiving gender reassignment services?
Is this an HMO out-of-network service request?

To submit a prior authorization Login Here.