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Effective 5/1/2025, out-of-network providers will be required to obtain authorization before rendering services to our Medicaid members. Please see our bulletin for details. Bulletin: Out-of-Network Prior Authorization Requirement
Effective 5/1/2025, out-of-network providers will be required to obtain authorization before rendering services to our Medicaid members. Please see our bulletin for details. Bulletin: Out-of-Network Prior Authorization Requirement

Medicaid Pre-Auth

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

 

Non-participating Laboratory providers must submit Prior Authorization for all services.

For non-participating Laboratory providers, Join Our Network.

Prior authorization is not required for any service(s) provided at a
Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). 
This applies to both in or out-of-network providers.

Prior Authorization at a Glance

Prior Authorization is NOT Required

Services being performed in the Emergency Department or Urgent Care Center or Family Planning services billed with a Contraceptive Management diagnosis do Not require prior authorization.

Prior Authorization IS Required

  • The member is being admitted to an inpatient facility.
  • Anesthesia services are being rendered for dental procedures.
  • Oral surgery services are being provided in the office.
  • The member is receiving hospice services.



To submit a prior authorization Login Here.

Tools and Resources

Specific clinical criteria available within the information linked below:

Last Updated: 06/04/2025