CarePlus Prior Authorization

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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 need to be verified by Opticare
Dental Services need to be verified by Denta Quest
Physical, Occupational and Speech Therapy services need to be verified by STRS
Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA
Behavioral Health, (Mental Health and Substance Use Disorder), needs to be verified by Cenpatico

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 these family planning services billed with a contraceptive management diagnosis?

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Are services, other than DME, orthotics, prosthetics, and supplies, being rendered in the home?
Is the member receiving hospice services?
Are anesthesia services being rendered for pain management?
Are plastic surgeon services being rendered in the office?