Medicaid Prior Auth
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.
Use the tool below to see if prior authorization (PA) is needed. If an authorization is required, submit a request through the secure provider portal or Availity. Visit the Service Authorization Program page for additional details.
Please note: Pre-service reviews for certain services are supported by Meridian vendor partners. For a list of applicable services and supporting vendors, reference the Vendor Solutions table below.
No PA is required for emergency or transportation services. All services for out-of-network providers, except emergency services, require prior authorization.
LTSS providers: Please contact the health plan for authorization requirements.
YouthCare providers: Please contact the health plan for authorization requirements.
Prior Authorization at a Glance
Prior Authorization is NOT Required
The following services do NOT require prior authorization:
- Services rendered in an emergency room or urgent care center
- Services rendered by a public health or welfare agency
- Family planning services billed with a contraceptive management diagnosis
Prior Authorization IS Required
The following services REQUIRE prior authorization:
- Services rendered by an out out-of-network provider, with the exception of emergency and urgent care services
- Admission of a member to an inpatient facility
- Hospice services
- Anesthesia services for pain management or 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 | Vendor Links |
|---|---|
| Dental | Envolve Dental |
| MRA, MRI, PET, CT scans, and Cardiac Imaging | Evolent |
| Pain Management | Evolent |
| Speech, Occupational and Physical Therapy | Evolent |
| Musculoskeletal Services | Evolent |
| Oncology/Supportive Drugs for Members Age 18 and Older | Evolent Specialty Services |
| Pharmacy | covermymeds |
| Non-Emergent Non-Ambulance Transportation | MTM |