Please note:

Please be advised that we are currently experiencing longer than normal hold times when calling our Medical Management Department at 1-833-863-1310. The preferred method for submitting authorizations is through the Secure Provider Portal at provider.ambetterofnorthcarolina.com. Once you submit your Prior Authorization request, the quickest method to check authorization status is through the Secure Provider Portal.

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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.

The following services (identifiable by procedure code search) need to be verified by Evolent, formely known as National Imaging Associates: Complex Imaging, MRA, MRI, PET, and CT scans; Speech, Occupational and Physical Therapy services (excluding chiropractor specialty providers – no authorization required); Pain Management.

Behavioral Health services need to be verified by Ambetter of North Carolina Inc.

Oncology Biopharmacy and Radiation Oncology drugs need to be verified by Evolent, formely known as New Century Health.


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. 

Are services being performed in the Emergency Department, or for Emergent Transportation?

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.