Pre-Auth Check Tool | Ambetter from Meridian

 

Pre-Auth Needed?

For the best experience, please use the Pre-Auth tool in Chrome, Firefox, or Internet Explorer 10 and above. 

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.

Vision services 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; Pain Management and Spinal Cord Stimulators; Speech, Occupational and Physical Therapy services (excluding chiropractor specialty providers – no authorization required), Musculoskeletal services for the spine, shoulder, hip and knee. 

Cardiac Surgical, Medical and Radiation Oncology Biopharmacy drugs for Participating Providers for Members 18 years and older need to be verified by New Century Health/Evolent. Non-Participating providers, please submit prior authorization requests through Meridian portal below.

Non-participating providers must submit Prior Authorization for all services. 

For non-participating providers, 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?

To submit a prior authorization Login Here.