Medicaid/CHIP Pre-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.
Vision services, including all services rendered by an Optician, Ophthalmologist or Optometrist need to be verified by Centene Vision
Dental services need to be verified by Centene Dental
Physical Therapy, Occupational Therapy, Speech Therapy, Interventional Pain Management (IPM), Left Heart Catheterization, Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by Evolent
Musculoskeletal Services Procedures need to be verified by TurningPoint.
Community Support Services need to be verified by MS Division of Medicaid
Basic laboratory chemistries and basic radiology do NOT require prior authorization for participating or non-participating providers.
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