Medicaid Pre-Auth
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 Centene Vision Services.
Dental Services need to be verified by Centene Dental Services.
Complex imaging, MRA, MRI, PET, and CT scans need to be verified by Evolent.
Non-participating providers must submit Prior Authorization for all services.
For non-participating providers, Join Our Network.
Are Services being performed in the Emergency Department or Urgent Care Center or 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 having observation services for more than 47 hours? | ||
| Are oral surgery services being provided in the office? | ||
| Are services other than DME, orthotics, prosthetics, supplies, and therapeutic injections, intravenous or subcutaneous injectable drugs being rendered in the home? | ||
| Is the member receiving hospice services? | ||
| Are services being rendered for Pain Management? | ||
| Are Anesthesia services being rendered for Dental procedures? |
To submit a prior authorization Login Here.
CMS Interoperability & Prior Authorization Final Rule: CY2025 Prior Authorization Requirements Reports and Metrics Summaries
In accordance with the Centers for Medicare & Medicaid Services (CMS) Final Rule (CMS 0057 F), we are annually publishing our prior authorization requirements and performance metrics to promote transparency, accountability, and better support our members and providers.
Reports:
- Nebraska Total Care CMS Final Rule 0057-F Prior Authorization Requirements: 112 (PDF)
- Nebraska Total Care Prior Authorization Metrics Summary: 112 (PDF)
The data presented in these publications reflects prior authorization requests processed during the applicable measurement year in accordance with CMS reporting specifications. Metrics are calculated using CMS defined methodologies and may not be directly comparable to alternative reports or third party summaries.
Norma Final de Interoperabilidad y Autorización Previa de los CMS: Resúmenes de Informes y Métricas sobre los Requisitos de Autorización Previa para el Año Calendario 2025
De conformidad con la Norma Final de los Centros de Servicios de Medicare y Medicaid (CMS) (CMS 0057 F), publicamos anualmente nuestros requisitos de autorización previa y métricas de desempeño con el fin de promover la transparencia y la rendición de cuentas, así como para brindar un mejor apoyo a nuestros miembros y proveedores.
Informes:
- Nebraska Total Care Norma Final 0057-F de los CMS: Requisitos de autorización previa: 112 (PDF)
- Nebraska Total Care Resumen de métricas de autorización previa: 112 (PDF)
Los datos presentados en estas publicaciones reflejan las solicitudes de autorización previa procesadas durante el año de medición aplicable, de conformidad con las especificaciones de presentación de informes de los CMS. Las métricas se calculan utilizando metodologías definidas por los CMS y podrían no ser directamente comparables con informes alternativos o resúmenes de terceros.