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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 need to be verified by Envolve Vision
Dental Services need to be verified by DentaQuest
Behavioral Health/Substance Abuse need to be verified by Buckeye Health Plan
Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA
Musculoskeletal Services and Cardiac Services need to be verified by Turning Point
Speech, Occupational and Physical Therapy need to be verified by NIA. For Chiropractic providers, no authorization is required.
Post-acute facility (SNF, IRF, and LTAC) prior authorizations need to be verified by CareCentrix ; Fax 877-250-5290
Services provided by Out-of-Network providers are not covered by the plan. Join Our Network
Note: Services related to an authorization denial will result in denial of all associated claims.
Would this be for Emergency Services?
|Types of Services||YES||NO|
|Are the services being performed or ordered by a non-participating provider?|
|Is the member being admitted to an inpatient facility with associated physician services?|
|Are anesthesia services being rendered for pain management or dental procedures?|
|Is the member receiving hospice services?|