Don’t delay, choose an Ambetter plan today – before Open Enrollment ends May 15.
Pre-Auth Check Tool | Ambetter from Meridian
For the best experience, please use the Pre-Auth tool in Chrome, Firefox, or Internet Explorer 10 and above.
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 Envolve Vision.
Dental services need to be verified by Envolve Dental.
Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA.
Speech, Occupational and Physical Therapy need to be verified by NIA. For Chiropractic providers, no authorization is required.
Musculoskeletal surgical services need to be verified by TurningPoint.
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?
|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 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?|