Pre-Auth Check Tool | Ambetter from Arizona Complete Health

 

Pre-Auth Check Tool

ATTENTION PROVIDERS: For authorization requests for date of service 1/1/18 and forward, utilize this tool to verify prior authorization requirements. To submit prior authorization by fax, please send to 866-597-7603.

DISCLAIMER: Your current browser's security settings does not allow the use of this tool. This tool requires the use of Internet Explorer 10 or Later. If you are currently using Internet Explorer as your browser and you see this message, you should try to update it or use another browser like Google Chrome or Firefox.
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. All new, re-sequenced and unlisted codes (miscellaneous codes) require prior authorization, regardless of place of service.

Vision Services are handled by EyeMed.

Dental Services are handled by Envolve Dental.

Complex Imaging, MRA, MRI, PET and CT scans need to be verified by Evolent

Musculoskeletal services need to be verified by Turning Point

Chiropractic services are handled by ASH.

Oncology/supportive drugs need to be verified by New Century Health


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 for Emergent Transportation?

Types of Services YES NO
ARE SERVICES BEING PERFORMED OR ORDERED BY A NON-PARTICIPATING PROVIDER (PROFESSIONALS/FACILITIES)?
IS THE MEMBER BEING ADMITTED TO AN INPATIENT FACILITY?
ARE ANESTHESIA SERVICES BEING RENDERED FOR DENTAL SURGERIES?
IS THE MEMBER RECEIVING GENDER REASSIGMENT SERVICES?
ARE SERVICES, OTHER THAN DME, ORTHOTICS, PROSTHETICS, SUPPLIES, X-RAYS, HOME VISITS (DOMICILIARY) CODES, HOME INFUSION OR LABS BEING RENDERED IN THE HOME?

 

For Home Health, please request prior authorizations through Professional Health Care Network (PHCN)