Pre-Auth Needed? | Ambetter de NH Healthy Families

 

Pre-Auth Needed?

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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. 

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.

Oncology/supportive drugs for members age 18 and older need to be verified by New Century Health

Effective for dates of service on and after 10-1-2020, Musculoskeletal Surgical Services Need to be Verified by TurningPoint. Please contact TurningPoint phone at 1-855- 909-6222 or by fax at 1-603-836-8903.

Speech, Occupational and Physical Therapy need to be verified by NIA

Post-acute facility (SNF, IRF, and LTAC) prior authorizations need to be verified by CareCentrix ; Fax 877-250-5290.


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 or Urgent Care?

Types of Services YES NO
Are services for EPO members 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?

To submit a prior authorization Login Here.