Medicaid Pre-Auth
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.
Utilization Management Reviews ensure our members get the right care, at the right time, in the right setting. Prior authorization is required before certain services are rendered to confirm medical necessity as defined by the member’s plan.
Use the Meridian tool to see if a pre-authorization is needed. If an authorization is needed, you can access our login to submit online. Please note some pre-service reviews are supported by Meridian Vendor partners. For a list of applicable services and supporting vendors, see the Vendor Solutions table below.
All Out of Network requests require prior authorization except emergency care, transportation, out-of-area urgent care or out-of-area dialysis and codes that state “No authorization required”. 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?
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? |
To submit a prior authorization Login Here.
For the best experience, please use the Pre-Auth tool in Chrome, Firefox, or Internet Explorer 10 and above.
MRA, MRI, PET, CT Scans, Cardiac Imaging and Pain Management | NIA |
Musculoskeletal Services | Turning Point |
Non-Emergent Non-Ambulance Transportation | MTM |
Oncology/Supportive Drugs for Members Age 18 and Older | New Century Health |
Other Supporting Documentation
Inpatient Medicaid Prior Authorization Form (PDF)
- 184 Factor VIII (PDF)
- Abaloparatide (Tymlos) (PDF)
- Abatacept (Orencia) (PDF)
- Aclidinium/Formoterol (Duaklir Pressair) (PDF)
- Acute and Chronic Opioid Therapy Policy (PDF)
- Adakevo (PDF)
- Adalimumab (Humira), Adalimumab-atto (Amjevita), Adalimumab-adbm (Cyltezo), Adalimumab-bwwd (Hadlima), Adalimumab-adaz (Hyrimoz) (PDF)
- Adefovir (Hepsera) (PDF)
- Aflibercept (Eylea) (PDF)
- Alemtuzumab (Lemtrada) (PDF)
- Alirocumab (Praluent) (PDF)
- Alpha 1-Proteinase Inhibitors (PDF)
- Ambrisentan (Letairis) (PDF)
- Anakinra (Kineret) (PDF)
- Apremilast (Otezla) (PDF)
- Aripiprazole Long-Acting Injection (Abilify Maintena, Aristada, Aristada Initio) (PDF)
- Avatrombopag (Doptelet) (PDF)
- Axitinib (Inlyta) (PDF)
- Aztreonam (Cayston) (PDF)
- Baricitinib (Olumiant) (PDF)
- Belimumab (Benlysta) (PDF)
- Benralizumab (Fasenra) (PDF)
- Betamethasone Dipropinate (Sernivo) (PDF)
- Bevacizumab (Avastin, Mvasi, Zirabev) (PDF)
- Brodalumab (Siliq) (PDF)
- Budesonide/Glycopyrrolate/Formoterol Fumarate (Breztri Aerosphere) (PDF)
- C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda, Ruconest) (PDF)
- Calcipotriene-Betamethasone Dipropionate Foam (Enstilar) (PDF)
- Cladribine (Mavenclad) (PDF)
- Certolizumba (Cimzia) (PDF)
- Clozapine (Fazaclo) (PDF)
- Clobazam (Onfi, Sympazan) (PDF)
- Colesevelam (Welchol) (PDF)
- Continuous Glucose Monitors (PDF)
- Contimuous Glucose Monitor Criteria (Dexcom) (PDF)
- Continuous Insulin Delivery Systems (Omnipod, Omnipod DASH) (PDF)
- Darbepoetin Alfa (Aranesp) (PDF)
- Dasabuvir/Ombitasvir/Paritaprevir/Ritonavir (Viekira Pak) (PDF)
- Deferasirox (Exjade, Jadenu) (PDF)
- Deferiprone (Ferriprox) (PDF)
- Delafloxacin (Baxdela) (PDF)
- Denosumab (Prolia, Xgeva) (PDF)
- Dermatology Class Criteria (PDF)
- Dimethyl Fumarate (Tecfidera), Diroximel Fumarate (Vumerity), Monomethyl Fumarate (Bafiertam) (PDF)
- Doxepin (Silenor) (PDF)
- Dipeptidyl Peptidase-4 (DPP-4) Inhibitors (PDF)
- Eculizumab (PDF)
- Efinaconazole (Jublia) (PDF)
- Elagolix (Orilissa), Elagolix/Estradiol/Norethinedrone (Oriahnn) (PDF)
- Elbasvir/Grazoprevir (Zepatier) (PDF)
- Eltrombopag (Promacta) (PDF)
- Emtricitabine/Tenofovir Alafenamide (Descovy) (PDF)
- Endari (PDF)
- Epoetin Alfa (Epogen, Procrit), Epoetin Alfa-epbx (Retacrit) (PDF)
- Epoprostenol (Flolan, Veletri) (PDF)
- Erenumab-aaoe (Aimovig) (PDF)
- Esketamine (Spravato) (PDF)
- Everolimus (Afinitor, Afinitor Disperz, Zortress) (PDF)
- Evolocumab (Repatha) (PDF)
- Farxiga (PDF)
- Fentanyl IR (Abstral, Actiq, Fentora, Lazanda, Subsys) (PDF)
- Ferric Maltol (Accrufer) (PDF)
- Filgrastim (Neupogen), Filgrastim-sndz (Zarxio), Tbo-filgrastim (Granix), Filgrastim-aafi (Nivestym) (PDF)
- Fingolimod (Gilenya) (PDF)
- Fluticasone Propionate (Xhance) (PDF)
- Fluticasone/Salmeterol (Advair Diskus, Advair HFA) (PDF)
- Fluticasone/Umeclidinium/Vilanterol (Trelegy Ellipta) (PDF)
- Fluticasone/Vilanterol (Breo Ellipta) (PDF)
- Formulary Exceptions (PDF)
- Fremanezumab-vfrm (Ajovy) (PDF)
- Gastrointestinal Agents (PDF)
- Gilteritinib (Xospata) (PDF)
- Glatiramer Acetate (Copaxone, Glatopa) (PDF)
- Glecaprevir/Pibrentasvir (Mavyret) (PDF)
- Global Medical Necessity (PDF)
- Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (PDF)
- Golimumab (Simponi, Simponi Aria) (PDF)
- Guselkumab (Tremfya) (PDF)
- Human Growth Hormone (Somapacitan, Somatropin) (PDF)
- Hyaluronate Derivatives (PDF)
- Ibalizumab-uiyk (Trogarzo) (PDF)
- Icatibant (Firazyr) (PDF)
- Icosapent Ethyl (Vascepa) (PDF)
- Immune Globulins (PDF)
- Indacaterol/Glycopyrrolate (Utibron Neohaler) (PDF)
- Infliximab (Remicade), Infliximab-axxq (Avsola), Infliximab-dyyb (Inflectra), Infliximab-abda (Renflexis) (PDF)
- Insulin Delivery Systems (V-Go, Omnipod, InPen) (PDF)
- Interferon Beta-1a (Avonex, Rebif) (PDF)
- Interferon Beta-1b (Betaseron, Extavia) (PDF)
- Interferon Gamma-1b (Actimmune) (PDF)
- Isotretinoin (Claravis, Absorica, Absorica LD, Myorisan, Zenatane) (PDF)
- Istradefylline (Nourianz) (PDF)
- Isturisa (PDF)
- Itraconazole (Sporanox) (PDF)
- Ixekizumab (Taltz) (PDF)
- Lasmiditan (Reyvow) (PDF)
- Lacosamide (Vimpat) (PDF)
- Lanadelumab-fylo (Takhzyro) (PDF)
- Ledipasvir/Sofosbuvir (Harvoni) (PDF)
- Linezolid (Zyvox) (PDF)
- Lomitapide (Juxtapid) (PDF)
- Lusutrombopag (Mulpleta) (PDF)
- Mecasermin (Increlex) (PDF)
- Med Neces for Drug not PDL (PDF)
- Mepolizumab (Nucala) (PDF)
- Methoxy Polyethylene Glycol-epoetin Beta (Mircera) (PDF)
- Migraine Prophylaxis – Preferred Agents (PDF)
- Milrinone (PDF)
- Mipomersen (Kynamro) (PDF)
- Mitoxantrone (Novantrone) (PDF)
- Mometasone Furoate (Sinuva) (PDF)
- Natalizumab (Tysabri) (PDF)
- Nintedanib (Ofev) (PDF)
- Non-Calcium Phosphate Binders (PDF)
- Non-Formulary Injectable Antibiotics (PDF)
- Non-Preferred Blood Glucose Monitors/Test Strips (PDF)
- Ocrelizumab (Ocrevus) (PDF)
- Octreotide Acetate (Sandostatin Injection, Sandostatin LAR Depot, Bynfezia, Mycapssa) (PDF)
- Olanzapine Long-Acting Injection (Zyprexa Relprevv) (PDF)
- Opioid Analgesics (PDF)
- Overactive Bladder Agents (PDF)
- Oxbryta (PDF)
- Ozanimod (Zeposia) (PDF)
- Paliperidone Long-Acting Injection (Invega Sustenna, Invega Trinza) (PDF)
- Pegfilgrastim (Neulasta), Pegfilgrastim-jmdb (Fulphila), Pegfilgrastim-cbqv (Udenyca), Pegfilgrastim-bmez (Ziextenzo), Pegfilgrastin-apgf (Nyvepria) (PDF)
- Peginterferon Alfa-2a,b (Pegasys, PegIntron, Sylatron) (PDF)
- Peginterferon Beta-1a (Plegridy) (PDF)
- Pegloticase (Krystexxa) (PDF)
- Perampanel (Fycompa) (PDF)
- Pirfenidone (Esbriet) (PDF)
- Pitolisant (Wakix) (PDF)
- Propranolol HCl Oral Solution (Hemangeol) (PDF)
- Ranibizumab (Lucentis) (PDF)
- Rasburicase (Elitek) (PDF)
- Request for Exceptions to the Formulary (PDF)
- Request for Non-Preferred Formulary Agents (PDF)
- Rifaximin (Xifaxan) (PDF)
- Rimegepant (Nurtec ODT) (PDF)
- Risankizumab-rzaa (Skyrizi) (PDF)
- Risperidone Long-Acting Injection (Perseris, Risperdal Consta) (PDF)
- Rituximab (Rituxan), Rituximab-pvvr (Ruxience), Rituximab-abbs (Truxima), Rituximab-Hyaluronidase (Rituxan Hycela) (PDF)
- Rivastigmine (Exelon) (PDF)
- Romiplostim (Nplate) (PDF)
- Romosozumab-aqqg (Evenity) (PDF)
- Rufinamide (Banzel) (PDF)
- Safinamide (Xadago) (PDF)
- Sapropterin Dihydrochloride (Kuvan) (PDF)
- Sarilumab (Kevzara) (PDF)
- Satralizumab-mwge (Enspryng) (PDF)
- Secukinumab (Cosentyx) (PDF)
- Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors (PDF)
- Siponimod (Mayzent) (PDF)
- Sodium Oxybate (Xyrem) and Calcium, Magnesium, Potassium, and Sodium Oxybate (Xywav) (PDF)
- Sofosbuvir (Sovaldi) (PDF)
- Sofosbuvir/Velpatasvir (Epclusa) (PDF)
- Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) (PDF)
- Solriamfetol (Sunosi) (PDF)
- Sunosi (PDF)
- Suvorexant (Belsomra) (PDF)
- Tadalafil (Adcirca, Alyq) (PDF)
- Taliglucerase Alfa (Elelyso) (PDF)
- Tasimelteon (Hetlioz, Hetlioz LQ) (PDF)
- Tazarotene (Arazlo, Fabior, Tazorac) (PDF)
- Teduglutide (Gattex) (PDF)
- Tegaserod (Zelnorm) (PDF)
- Tepezza (PDF)
- Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase (PDF)
- Teriflunomide (Aubagio) (PDF)
- Teriparatide (Forteo) (PDF)
- Testosterone (PDF)
- Tildrakizumab-asmn (Ilumya) (PDF)
- Tiotropium/Olodaterol (Stiolto Respimat) (PDF)
- Tocilizumab (Actemra) (PDF)
- Triamcinolone ER Injection (Zilretta) (PDF)
- Ubrogepant (Ubrelvy) (PDF)
- Umeclidinium/Vilanterol (Anoro Ellipta) (PDF)
- Upadacitinib (Rinvoq) (PDF)
- Ustekinumab (Stelara) (PDF)
- Vedolizumab (Entyvio) (PDF)
- Verteporfin (Visudyne) (PDF)
- Vigabatrin (Sabril) (PDF)
- Vyepti (PDF)
- Wakix (PDF)
- Zoledronic Acid (Reclast, Zometa) (PDF)