Pre-Auth Check Tool | Ambetter from Buckeye Health Plan

 

Pre-Auth Needed?

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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

Behavioral Health/Substance Abuse need to be verified by Buckeye Health Plan

The following services (identifiable by procedure code search) need to be verified by Evolent: Complex Imaging, MRA, MRI, PET, and CT scans; Speech, Occupational and Physical Therapy (excluding chiropractor specialty providers – no authorization required); Musculoskeletal services for the spine, shoulder, hip and knee.

Cardiac services need be verified by TurningPoint.

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

Oncology/supportive drugs need to be verified by 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.

 

Would this be for Emergency Services?

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 with associated physician services?
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.