Submit a Prior Authorization

FOR MEDICAL PROFESSIONAL USE ONLY

Prior Authorization Instructions

For Meridian Medicare-Medicaid Plan plan information on how to submit a prior authorization request, please refer to our new authorization lookup tool.

For pharmacy authorization requests, visit Pharmacy.

Meridian partners with several external entities to manage prior authorizations for certain services or populations. The following grid outlines all entities including the request submission options, applicable plans, and delegated services.

Alternately, view Prior Authorization requirements, training tools, submission options and user guides online.

FOR MEDICAL PROFESSIONAL USE ONLY

Prior Authorization Instructions

Prior authorization (PA) is required before certain services are rendered to confirm medical necessity. No PA is required for emergency or transportation services. All services for out-of-network providers, except emergency services, require prior authorization. Criteria utilized in decision making can be accessed through the secure provider portal.

How to Request a Prior Authorization

• Determine if a PA is needed with the Meridian Prior Auth Check tool.
• Submit PAs electronically through the secure provider portal for the most convenient service.
  • First-time users: Create a new portal account for 24/7 access to patient lists, health information, and plan eligibility & the ability to submit and check the status of claims and authorizations.