Skip to Main Content

Medicaid Pre-Auth

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. 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

Contact Envolve Dental for services performed during transition dates

Complex imaging, CT, PET, MRA, MRI, and high tech radiology procedures need to be authorized by NIA

Musculoskeletal Services need to be verified by Turning Point

Home health services need to be verified by Sunshine Health. DME/home infusion form (PDF)

Outptatient Therapy requests (PT, OT, ST) are managed through HN1. HN1 can be reached at 1-888-550-8800, or visit ATA of Florida.

Non-participating providers must submit Prior Authorization for all services
For non-participating providers, Join Our Network

 

Would this be for services rendered in the Emergency Room or Urgent Care Center; or are services being rendered by Public Health or Welfare Agency; or are these Family Planning services billed with a contraceptive management diagnosis?

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Is the member receiving hospice services?
Are anesthesia services being rendered for pain management or dental procedures?
Are services other than DME, orthotics, prosthetics, supplies, and therapeutic injections being rendered in the home?