Medicare Pre-Auth

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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 that prior authorization is needed, please submit a request for an accurate response

Complex imaging, MRA, MRI, PET, CT Scans and Therapy need to be verified by NIA.

The following services need to be verified by Evolent for Participating providers: Cardiac Surgical services for Members 19 years and older; Medical and Radiation Oncology Biopharmacy drugs. Non-participating providers must contact the health plan.

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 are services for Dialysis or Hospice?

Yes No

Types of Services	YES	NO
Is the member being admitted to an inpatient facility?	serviceQuestion-0	serviceQuestion-0
Are anesthesia services being requrested for pain management, dental surgery or services in the office rendered by a non-participating provider?	serviceQuestion-1	serviceQuestion-1
Is this an HMO Out of Network service request?	serviceQuestion-2	serviceQuestion-2

Medicare Pre-Auth

Are Services being performed in the Emergency Department or Urgent Care Center, or are services for Dialysis or Hospice?

Prior Authorization is NOT required

Enter the code of the service you would like to check:

To submit a prior authorization Login Here.