Pre-Auth Needed?

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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 if prior authorization is needed, please submit a prior authorization request and a response will be provided.

Behavioral Health/Substance Abuse services need to be verified by the community Mental Health Authority/PIHP in the beneficiary’s county of residence;

 

Macomb County Community Mental Health Authority/PIHP.

Detroit Wayne County Community Mental Health Authority/PIHP.

 

Vision services need to be verified by National Vision Administrators.

Dental Services need to be verified by Liberty Dental.

Transportation services need to be verified by Logisticare.

 

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 performed in the Emergency Department, or Urgent Care, or are the services for dialysis or Hospice?

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Are services, other than lab, radiology, domiciary visits or DME being rendered in the home?
Are anesthesia services being rendered for pain management or dental surgeries?

 

Last Updated: 09/30/16
H9487_Website17R_Approved_04182017