Medicaid Prior Auth
DISCLAIMER: All attempts are made to provide the most current information in the Prior Auth Check 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.
Use the tools below before submitting a PA.
- Visit our Service Authorization Programs page for a searchable list of procedure codes, applicable clinical review criteria, an historical log of PA changes, and more.
- If PA is required, submit a request through Availity.
- Meridian vendor partners support pre-service reviews for certain services. Applicable procedures are indicated in the Prior Auth Check Tool.
HCBS waiver providers: Contact our LTSSUM@mhplan.com inbox with specific questions about an existing or recently terminated authorization.
Prior Authorization at a Glance
Prior Authorization is NOT Required
The following services do NOT require prior authorization:
- Emergency services, including emergency medical screenings
- Crisis stabilization care*
- Unplanned inpatient admissions*
- Inpatient and outpatient behavioral healthcare*
- Substance use residential treatment*
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services
- Family planning and reproductive health services
- Local health department services
- Preventive prenatal, perinatal, and postpartum services
- School-based health center services (including dental programs)
*Notification requirements apply. Find additional guidance on the Service Authorization Programs page.
Prior Authorization IS Required
The following services REQUIRE prior authorization:
- Services rendered by an out-of-network provider, except for emergency and urgent care services
- Elective inpatient admissions
- Skilled nursing, long-term acute care, and rehabilitation facility admissions
- Hospice services
- Anesthesia services for pain management and dental procedures
- Services rendered at home, other than DME, orthotics, prosthetics, supplies, and therapeutic injections
- Services rendered by a chiropractor
Prior Authorization Check
To submit a prior authorization Login Here
Vendor Solutions
Consult each vendor for authorization submission requirements.
Service Types | Vendor Links |
|---|---|
| Dental | Centene Dental Services |
| MRA, MRI, PET, CT scans, and Cardiac Imaging | Evolent |
| Pain Management | Evolent |
| Speech, Occupational and Physical Therapy | Evolent |
| Musculoskeletal Services | Evolent |
| Non-Emergent Non-Ambulance Transportation | MTM |