Pre-Auth Needed?

For the best experience, please use the Pre-Auth tool in Chrome, Firefox, or Internet Explorer 10 and above.

DISCLAIMER: Your current browser's security settings does not allow the use of this tool. This tool requires the use of Internet Explorer 10 or Later. If you are currently using Internet Explorer as your browser and you see this message, you should try to update it or use another browser like Google Chrome or Firefox.

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 ServicesExternal Link.

Dental services need to be verified by Centene Dental ServicesExternal Link.

The following services need to be verified by EvolentExternal Link: Speech, occupational & physical therapy; Complex Imaging, MRA, MRI, PET & CT scans; Musculoskeletal services for shoulder, hip, spine and knee surgery; Pain management and spinal cord stimulator services. Chiropractic specialty providers are NOT managed by Evolent.

The following services need to be verified by EvolentExternal Link: Cardiac surgical, Medical and Radiation Oncology Biopharmacy drugs for Participating Providers for Members age 18 years and older. Non-participating providers, please submit prior authorization requests through Meridian portal below.

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?

Yes No

Types of Services	YES	NO
Are the services being performed or ordered by a non-participating provider (professionals/facilities)?	serviceQuestion-0	serviceQuestion-0
Is the member being admitted to an inpatient facility?	serviceQuestion-1	serviceQuestion-1
Are anesthesia services being rendered for dental surgeries?	serviceQuestion-2	serviceQuestion-2
Are oral surgery services being provided in the office?	serviceQuestion-3	serviceQuestion-3
Is the member receiving Gender Affirming services?	serviceQuestion-4	serviceQuestion-4

Pre-Auth Check Tool | Ambetter from Meridian

Pre-Auth Needed?

Are Services being performed in the Emergency Department?

Services being performed in the Emergency Department or for Emergent Transportation do NOT require prior authorization.

Enter the code of the service you would like to check:

To submit a prior authorization Login Here.