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Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how
Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how

Out-of-Network Providers Prior Authorization Requirements Update

Date: 09/06/24

Meridian and YouthCare are committed to collaborating with providers to ensure our members achieve optimal health outcomes. To best serve providers and members, we encourage the development of strong relationships with qualified, high-performing providers. And to improve member quality of service and care gap closure outcomes, we are collaborating with our in-network partnerships to optimize those relationships.

With these goals in mind, effective October 1, 2024, all services for out-of-network providers will be paid at the standard Meridian or YouthCare in-network Medicaid rates applicable for each provider type.

Additionally, all services rendered by out-of-network providers will require prior authorization, except for the services listed below.

  • Emergency services
  • Ambulance
  • Nursing facilities (must be on Patient Credit File)
  • Laboratory, radiology, pathology, and anesthesiology rendered in places of service codes 20, 21, 23, 31, 32, 51, 54, 61.

Access the Meridian prior authorization tool, clinical and payment policies, and apply to join our network, or contact Meridian Provider Services at 866-606-3700, Monday through Friday, from 8 a.m. to 5 p.m. for more information.

Or access the YouthCare prior authorization page and tool, clinical and payment policies page, or contact YouthCare Provider Services at 844-289-2264, Monday through Friday, from 8 a.m. to 6 p.m.