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Pre-Auth Check Tool
Pre-Auth Check Tool
ATTENTION PROVIDERS: For authorization requests for date of service 1/1/18 and forward, utilize this tool to verify prior authorization requirements. To submit prior authorization by fax, please send to 800-314-6223.
All attempts are made to provide the most current information on the Pre-Auth Needed Tool. A prior authorization is not a guarantee of payment. Payment may be denied in accordance with Plan’s policies and procedures and applicable law. 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 are handled by EyeMed.
Dental Services are handled by Your Dental Plan.
High Tech Imaging services are handled by NIA.
Musculoskeletal Services need to be verified by Turning Point
Behavioral Health services are handled by MHN.
Chiropractic services are handled by ASH.
Oncology/supportive drugs need to be verified by New Century Health.
For Home Health, please request prior authorizations through Professional Health Care Network (PHCN)
-Log into PHCN portal at https://professionalcares.com/
-Call PHCN at 602-395-5100
-Fax to 480-359-3834
Services provided by Out-of-Network providers are not covered by the plan. Join Our Network.
NOTE: Services related to an authorization denial will result in denail of all associated claims.
Are services being performed in the Emergency Department, or for Emergent Transportation?
|Types of Services||YES||NO|
|ARE SERVICES BEING PERFORMED OR ORDERED BY A NON-PARTICIPATING PROVIDER?|
|IS THE MEMBER BEING ADMITTED TO AN INPATIENT FACILITY?|
|ARE ANESTHESIA SERVICES BEING RENDERED FOR PAIN MANAGEMENT OR DENTAL SURGERIES?|
|IS THE MEMBER RECEIVING HOSPICE SERVICES?|
|IS THE MEMBER RECEIVING GENDER REASSIGMENT SERVICES?|
|ARE SERVICE BEING RENDERED IN THE HOME EXCLUDING SLEEP STUDIES, DME, MEDICAL EQUIPMENT SUPPLIES, ORTHOTICS AND PROSTHETICS?|