Pre-Auth Check Tool

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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.  All new, re-sequenced and unlisted codes (miscellaneous codes) require prior authorization, regardless of place of service.

Vision services need to be verified by Centene Vision Services.

Dental services need to be verified by Centene Dental Services.

The following services need to be verified by Evolent: Complex Imaging, MRA, MRI, PET & CT scans.

The following services need to be verified by Evolent: Medical and Radiation Oncology / Biopharmacy drugs.

NOTE: Services identified as administered by a Vendor may be specific to certain provider specialties, locations, procedure and diagnosis codes. For example, services rendered by via Telehealth locations are NOT managed by Evolent. Any service rejected by the Vendor as outside of their scope of managed services, please enter a request to establish Health Plan authorization requirements. 

Cardiac Surgical and Musculoskeletal services for shoulder, hip, spine and knee surgery need to be verified by Turning Point.

Chiropractic services are managed by ASH.


Services provided by Out-of-Network providers are not covered by the plan,
. without prior authorization. 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 Affirming services?

To submit a prior authorization Login Here.