Pre-Auth Needed?


Pre-Auth Needed?

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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

Routine Vision or Medical Services performed by an Optometrist need to be verified by Envolve Vision.

Dental Services need to be verified by Envolve Dental.

The following services (identifiable by procedure code search) need to be verified by Evolent: Complex Imaging, MRA, MRI, PET, and CT scans; Speech, Occupational and Physical Therapy services; Musculoskeletal services for the spine, shoulder, hip and knee; Spinal Cord Stimulators and Pain Management services need to be verified by Evolent.

Cardiac surgical, Oncology Biopharmacy, Medical and Radiation Oncology services need to be verified by New Century Health.

Services provided by Out-of-Network providers are not covered by the plan. Join Our Network.

Are Services being performed in the Emergency Department?

Types of Services YES NO
Are the services being performed or ordered by a non-participating provider (professionals/facilities)?
Is the member being admitted to an inpatient facility?
Are anesthesia services being rendered for dental surgeries?
Are oral surgery services being provided in the office?
Is the member receiving gender reassignment services?