Medicaid Prior Authorization
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.
Vision services need to be verified by Envolve Vision Services
Dental services need to be verified by DentaQuest
Musculoskeletal Services need to be verified by Turning Point
Non-participating providers must submit prior authorization for all services*
For non-participating providers, Join Our Network
*Please note, Incontinence Supplies ordered through the preferred DME provider do not require prior authorization.
Would this be for Family Planning services billed with a contraceptive management diagnosis OR Is this service for a Star Kids or Star Health Member for school based telemedicine?
| Types of Services | YES | NO |
|---|---|---|
| Are services being provided by a non-participating provider? | ||
| Is the member being admitted to an inpatient facility? | ||
| Is the member receiving oral surgery services? | ||
| Is the member receiving plastic and reconstructive surgeon services? | ||
| Is the member receiving podiatry services? |
To submit a prior authorization Login Here.
To access Superior clinical and payment policies, visit Clinical & Payment Polices.