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.
Please check the State Medicaid Guidelines for Covered Benefits.
Vision Services need to be verified by Opticare.
Dental Services need to be verified by DSHS.
Complex imaging, MRA, MRI, PET, and CT scans need to be verified by NIA.
Behavioral Health/Substance Abuse need to be verified by Cenpatico.
Emergency and Urgent Care Services do NOT require prior authorization.
|Type of service||Authorization Required?|
|Anesthesia services for pain management or oral surgery||YES|
|Oral specialty provider in an office setting||YES|
|Services rendered in the home||YES|
|Family Planning services billed with a V25 through V25.9 diagnosis||NO|
If an authorization is required for the requested procedure, to submit an authorization Login here.