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 whether or not a prior authorization is needed, please submit a request for an accurate response.
Complex imaging, MRA, MRI, PET, and CT scans need to be verified by NIA
Dental Services need to be verified by Envolve Dental
For Home Health, please request through Professional Cares
Musculoskeletal Services need to be verified by Turning Point
Transportation services are handled by Medical Transportation Brokerage of Arizona (MTBA)
Non-participating providers must submit Prior Authorization for all services except those performed in the Emergency Department.
For non-participating providers, Join Our Network.
Are Services being performed in the Emergency Department or Family Planning services billed with a Contraceptive Management diagnosis?
|Types of Services||YES||NO|
|Is the member being admitted to an inpatient facility?|
|Are services being rendered for pain management?|
|Are services, other than DME, orthotics, prosthetics, supplies, x-rays, home visits (DOMICILLARY) codes, therapeutic injections or labs being rendered in the home?|
|Are services being rendered in an unspecified location/place of service (other)?|