Ambetter 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.
Routine Vision Services are not covered by this Health Plan. Medical Services provided by an Optometrist, Optician or Opthalmologist need to be verified by Envolve Vision.
Behavioral Health/Subtance Abuse services need to be verified by NH Healthy Families.
Complex Imaging, MRA, MRI, PET and CT Scans need to be verified by NIA.
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 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? | ||
| Are services being rendered in the home, excluding Sleep Studies, DME, Medical Equipment Supplies, Orthotics and Prosthetics? |