Medicaid Prior Auth
For the best experience, please use the Prior Auth tool in Chrome, Firefox, or Internet Explorer 10 and above.
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.
Use the tool below to see if prior authorization (PA) is needed. If an authorization is required, submit a request using the secure provider portal, or review fax submission options.
Please note: Pre-service reviews for certain services are supported by Meridian vendor partners. For a list of applicable services and supporting vendors, reference the Vendor Solutions table below.
No PA is required for emergency or transportation services. All services for out-of-network providers, except emergency services, require prior authorization.
LTSS providers: Please contact the health plan for authorization requirements.
Answer these questions to get started:
Are Services being performed in the Emergency Department or Urgent Care Center or are the services for dialysis?
| Types of Services | YES | NO |
|---|---|---|
| Is the member being admitted to an inpatient facility? | ||
| Are chiropractic services being rendered after the 12th visit? | ||
| Are services other than DME, orthotics, prosthetics and supplies being provided in the home? | ||
| Are hospice services being provided? |
To submit a prior authorization Login Here.
| Vendor Solutions | Vendor Links |
|---|---|
| Dental | Envolve Dental |
| MRA, MRI, PET, CT scans, and Cardiac Imaging | Evolent |
| Pain Management | Evolent |
| Speech, Occupational and Physical Therapy | Evolent |
| Musculoskeletal Services | Evolent |
| Oncology/Supportive Drugs for Members Age 18 and Older | Evolent Specialty Services |
| Pharmacy | covermymeds |
| Post-acute facility (SNF, IRF, and LTAC) | CareCentrix Fax: 877-250-5290 |
| Non-Emergent Non-Ambulance Transportation | MTM |
Prior Authorization Fax Submission Forms
Inpatient Medicaid Prior Authorization Form (PDF)
Outpatient Medicaid Prior Authorization Form (PDF)