Prior Authorization

DISCLAIMER: Your current browser's security settings does not allow the use of this tool. This tool requires the use of Internet Explorer 10 or Later. If you are currently using Internet Explorer as your browser and you see this message, you should try to update it or use another browser like Google Chrome or Firefox.

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 verify prior authorization (PA). If an authorization is required, submit a request using the secure provider portal.

Please note: Pre-service reviews for certain services are supported by Meridian Medicare-Medicaid Plan vendor partners. See the Vendor Solutions table below for details.

All services for out-of-network providers require PA, except emergency care, out-of-area urgent care, or out-of-area dialysis.

LTSS providers, please contact the health plan for authorization requirements.

Answer these questions to get started:

Are services being performed in the Emergency Department or Urgent Care Center or for Dialysis or Family Planning services billed with a Contraceptive Management diagnosis?

Yes No

Types of Services	YES	NO
Is the member being admitted to an inpatient facility?	serviceQuestion-0	serviceQuestion-0
Are anesthesia services being requested for pain management?	serviceQuestion-1	serviceQuestion-1
Is a non-par provider rendering services other than flu/pneumonia shots?	serviceQuestion-2	serviceQuestion-2

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
Non-Emergent Non-Ambulance Transportation	MTM

Prior Authorization

Are services being performed in the Emergency Department or Urgent Care Center or for Dialysis or Family Planning services billed with a Contraceptive Management diagnosis?

Services being performed in the Emergency Department or Urgent Care Center or services for dialysis or Hospice do NOT require prior authorization.

Enter the code of the service you would like to check:

To submit a prior authorization Login Here.

Resources

Prior Authorization

Are services being performed in the Emergency Department or Urgent Care Center or for Dialysis or Family Planning services billed with a Contraceptive Management diagnosis?

Services being performed in the Emergency Department or Urgent Care Center or services for dialysis or Hospice do NOT require prior authorization.

Enter the code of the service you would like to check:

To submit a prior authorization Login Here.

Resources

Drug Approval Criteria