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

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

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Are chiropractic services being rendered after the 12th visit?
Are services other than DME, orthotics, prosthetics and supplies being provided in the home?
Are hospice services being provided?

Tools and Resources

Specific clinical criteria available within the information linked below: