PPO Pre-Auth Check
All attempts are made to provide the most current information on the Pre-Auth Needed Tool. A prior authorization is not a guarantee of payment. Payment may be denied in accordance with Plan’s policies and procedures and applicable law. 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.
Dental Services are handled by Your Dental Plan.
Vision Services are handled by EyeMed.
High Tech Imaging services are handled by NIA.
Radiation Therapy and Sleep Studies are handled by Evicore.
Behavioral Health services are handled by MHN.
NOTE: A penalty will apply to services where prior authorization is not obtained if found to be medically necessary. Services will be denied if medical necessity is not established.
Are services being performed in the Emergency Department, Urgent Care, or for Emergent Transportation?
|Types of Services||YES||NO|
|IS THE MEMBER BEING ADMITTED TO AN INPATIENT FACILITY?|
|IS THE MEMBER RECEIVING HOSPICE SERVICES?|
|IS THE MEMBER BEING TREATED FOR TMJ?|
|IS THE MEMBER TAKING PART IN A CLINICAL TRIAL?|