HMO Pre-Auth Check

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DISCLAIMER:

All attempts are made to provide the most current information on the Pre-Auth Needed Tool. A prior authorization is not a guarantee of payment. Payment may be denied in accordance with Plan’s policies and procedures and applicable law. 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.

  • Dental Services are handled by Your Dental Plan.
  • Vision Services are handled by EyeMed.
  • High Tech Imaging services are handled by Evolent.
  • Radiation Therapy and Sleep Studies are handled by eviCore healthcare.
  • Acupuncture and Chiropractic services are handled by ASH.
  • Musculoskeletal Services need to be verified by TurningPoint.
  • Refer to the Pharmacy auth guidelines to confirm authorization requirements for pharmacy benefit services.

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

 

Are services being performed in the Emergency Department, Urgent Care, for Emergent Transportation or biomarker testing for an insured with advanced or metastatic stage 3 or 4 cancer?

Types of Services YES NO
IS THE MEMBER BEING ADMITTED TO AN INPATIENT FACILITY?
IS THE MEMBER TAKING PART IN A CLINICAL TRIAL?
IS THE MEMBER HAVING TMJ SERVICES?
ARE SERVICES FOR GENDER REASSIGNMENT?

To submit a prior authorization Login Here.