Pre-Auth Check Tool | Ambetter from NH Healthy Families

 

Pre-Auth Needed?

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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.  Claim payment depends on member 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 Centene Vision Services.

Dental services need to be verified by Centene Dental Services.

Behavioral Health/Substance Abuse services need to be verified by New Hampshire Healthy Families.

The following services need to be verified by Evolent: Speech, occupational & physical therapy; Complex Imaging, MRA, MRI, PET & CT scans; Musculoskeletal services for shoulder, hip, spine and knee surgery; Left Heart Catheterization & Implantable Services; Pain management and spinal cord stimulator services. Chiropractic specialty providers are NOT managed by Evolent.  Home health agencies with episodic care agreements are verified with New Hampshire Health Families.

Post-acute facility (SNF, IRF and LTAC) services need to be verified by CareCentrix:  Fax 877-250-5290


Services provided by Out-of-Network providers are not covered by the plan, without prior authorization.  Join Our Network.

Note: Services related to an authorization denial will result in denial of associated claims.

 

 

Are Services being performed in the Emergency Department, Urgent Care, or for Emergent Transportation?

Types of Services YES NO
Are the services for EPO members 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 Affirming services?

To submit a prior authorization Login Here.