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Pre-Auth Check Tool | Ambetter from Home State Health
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.
ATTENTION: Effective January 1, 2021 Prior Authorization Requests should be submitted via our secure provider web portal. To submit a prior authorization Login Here. Copies of all supporting clinical information are required for prior authorizations. Lack of clinical information may result in delayed determination or an adverse determination.
Speech, Occupational and Physical Therapy need to be verified by NIA. For Chiropractic providers, no authorization is required.
Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA
Oncology/supportive drugs for members age 18 and older need to be verified by New Century Health.
Musculoskeletal and Cardiac services need to be verified by TurningPoint. Please contact TurningPoint at 1-855-777-7940 or by fax at 1-573-469-4352.
Are services being performed in the Emergency Department, or for Emergent Transportation?
|Types of Services||YES||NO|
|ARE SERVICES BEING PERFORMED OR ORDERED BY A NON-PARTICIPATING PROVIDER?|
|IS THE MEMBER BEING ADMITTED TO AN INPATIENT FACILITY?|
|ARE ANESTHESIA SERVICES BEING RENDERED FOR DENTAL SURGERIES?|
|IS THE MEMBER RECEIVING GENDER REASSIGMENT SERVICES?|