Pre-Auth Check
Use our tool to see if a pre-authorization is needed. It's quick and easy. If an authorization is needed, you can access our login to submit online. For the best experience, please use the Pre-Auth Tool in Chrome, Firefox, or Internet Explorer 10 and above.
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, and 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 are provided through Delta Dental or MCNA. Please verify.
Complex imaging, MRA, MRI, PET, and CT scans need to be verified by NIA.
Prior Authorizations for Musculoskeletal Procedures should be verified by TurningPoint.
Non-participating providers must submit Prior Authorization for all services.
Would this be Emergency or Urgent Care, Dialysis, or are these family planning services billed with a contraceptive management diagnosis?
| Types of Services | YES | NO |
|---|---|---|
| Is the member being admitted to an inpatient facility? | ||
| Are anesthesia services being rendered for pain management? | ||
| Are oral surgeon services being rendered in the office? | ||
| Are chiropractic services being rendered? | ||
| Are services, other than DME, orthotics, prosthetics, and supplies, being rendered in the home? | ||
| Are hospice services being provided? |