Pre-Auth Needed?

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

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.

Speech, Occupational & Physical Therapy; Complex imaging, MRA, MRI, PET & CT scans; Musculoskeletal services for the spine, shoulder, hip and knee; Spinal Cord Stimulators and identified Pain Management services need to be verified by Evolent.

Effective for dates of service 3/1/2024 forward:  Cardiac, Oncology Biopharmacy, Medical and Radiation Oncology services (identifiable by procedure code search) 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?