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Prior Authorization Check

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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.  

Dental Services need to be verified by Delta Dental.

The following services need to be verified by Evolent
Complex imaging, MRA, MRI, PET, and CT scan
Musculoskeletal services and Pain Management
The following services need to be verified by New Century Health
Cardiology, Medical and Radiation Oncology



For non-participating providers, Join Our Network.


Are Services being performed in the Emergency Department or Urgent Care Center or for Dialysis or Family Planning services billed with a Contraceptive Management diagnosis?

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Are anesthesia services being requested for pain management?
Is a non-par provider rendering services other than flu/pneumonia shots?