Long Term Care Pre-Auth

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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 upon 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 need to be verified by Envolve Dental 

All Out of Network requests require prior authorization except emergency care, out-of-area urgent care or out-of-area dialysis.
For non-participating providers, Join Our Network 

Are Services being rendered in Emergency room or urgent care for dialysis treatment?

Types of Services YES NO
Is the member being admitted to an inpatient facility or observation stay exceeding 24 hours?
Is the patient receiving Hospice Services? Are services being rendered by a Hospice Provider?
Are anesthesia services being rendered for pain management or dental anesthesia?
Are Home Health Care Services,other than DME, orthotics, prosthetics, and supplies, being rendered?
Are podiatry services being rendered in the office for members under the age of 21?
Are services being provided by a chiropractor, plastic or oral surgeon in the office?
Are services for transplant evaluation and or procedures?