Pre-Auth Check | Ambetter from Magnolia Health

 

Pre-Auth Needed?

Effective October 12, 2020, we are no longer sending hard copy or paper notifications for authorization approvals. Hard copies of denial letters will still be mailed to both provider and member. Approvals and denials will be available in real time in our secure provider portal.

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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.

Vision services, including all services rendered by an Optician, Ophthalmologist or Optometrist need to be verified by Envolve Vision
Dental services need to be verified by Envolve Dental
Behavioral Health/Substance Abuse need to be verified by Magnolia

Complex imaging, MRA, MRI, PET & CT scans; Left Heart Catheterization & Implantable services need to be verified by NIA

Musculoskeletal services need to be verified by TurningPoint.
Speech, Occupational and Physical Therapy need to be verified by NIA. For Chiropractic providers, no authorization is required.
Oncology Biopharmacy and Radiation Oncology drugs need to be verified by New Century Health.
Post-acute facility (SNF, IRF, and LTAC) prior authorizations need to be verified by CareCentrix; Fax 877-250-5290


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 denial of all associated claims.

 

Are Services being performed in the Emergency Department?

Types of Services YES NO
Are the 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 dental surgeries?
Is the member receiving Gender Reassignment services?

To submit a prior authorization Login Here.