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 Medicare Advantage provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.
Complex imaging, MRA, MRI, PET scans, Physical Medicine, Pain Management and Left Heart Catheterization need to be verified by NIA.
Musculoskeletal Services Procedures need to be verified by TurningPoint.
Non-participating providers must submit Prior Authorization for all services.
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 or hospice?
|Types of Services||YES||NO|
|Is the member being admitted to an inpatient facility?|
|Are anesthesia services being requested for pain management, dental surgery or services in the office rendered by a non-participating provider?|
|Is this an HMO Out of Network service request?|