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Prior Authorization

Some covered services or medications may need approval from Meridian, this is called a Prior Authorization (PA). You do not need a paper referral from Meridian to see a provider, but your provider may need to request a prior authorization from Meridian for a service to be approved.

The recently passed Prior Authorization Reform Act is helping us make our services even better. This bill took effect January 1, 2022.

Our prior authorization process will see many improvements. We will be more clear with processes. And we will reduce wait times for things like tests or surgeries. You will also see improved fairness with our PA process.

Our current PA process is NCQA certified. It meets many of the new law's standards. However, we see this as a time to continue improving our services.

For clinical criteria, please see the information linked below. To request PA information or receive additional support, please contact us at memberservices.mi@centene.com or 1-888-437-0606 (TTY: 711).

Do I need a referral to see a specialist?

No, you do not need a referral from your PCP to see a specialist. You do not need a referral for routine vision care, chiropractic services, or mental health/counseling services.

Below is a list of services that require prior authorization from Meridian before your healthcare provider can proceed with treatment. 

Services that require a Prior AuthorizationPrior Authorization Required for some or all of the Services
Immunizations & Vaccines (shots)Some services may require prior authorization
CircumcisionsSome services may require prior authorization
Birth ControlSome items may require prior authorization
Obstetric and Maternity CareSome services may require prior authorization
AbortionsYes
Medical Inpatient CareYes
Skilled Nursing FacilityYes
Inpatient RehabilitationYes
Long Term Acute Care HospitalYes
Cardiac and Pulmonary RehabSome services may require prior authorization
Home Health CareYes
Specialty Care (Office Visits and Clinics)Yes
Diagnostic Testing Urinalysis and Urine CulturesYes
Radiology Services (X-rays)Some services may require prior authorization
Rehabilitative/Habilitative Services and DevicesSome services may require prior authorization
Hearing AidsYes
Asthma SuppliesSome items may require prior authorization
Prosthetics/OrthoticsSome items may require prior authorization
Medical SuppliesSome items may require prior authorization
Durable Medical Equipment (Wheelchairs, walkers, hospital beds, etc.)Some items may require prior authorization
Non-emergent, Inpatient, Ambulatory, Outpatient, Emergency and Reconstructive SurgeriesSome services may require prior authorization
TransplantsYes
Hospice CareYes
Eye Care and EyeglassesSome services may require prior authorization
Diabetes CareSome services may require prior authorization
Prescription and Over the Counter (OTC) DrugsSome items may require prior authorization
Weight Management (WM)Yes
Pain Management InjectionsSome services may require prior authorization
Miscellaneous, unlisted, or no other specified proceduresYes
Specialty care (office visits and clinics)Some services may require prior authorization
Diagnostic Testing Urinalysis and Urine CulturesSome services may require prior authorization
Non-emergent Out of State CareSome services may require prior authorization
Last Updated: 08/05/2022