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Prior Authorization Check

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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.  

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?

To submit a prior authorization Login Here.

Last Updated: 10/01/2024

H0480_WEBSITE_2025 Accepted 09302024


Last Updated: 10/01/2024

H0480_WEBSITE_2025 Accepted 09302024

MeridianComplete (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Michigan Medicaid to provide benefits of both programs to enrollees. This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the MeridianComplete Member Handbook. Out-of-network/non-contracted providers are under no obligation to treat MeridianComplete members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services. You can get this document for free in other formats, such as large print, braille, or audio. Call 1-855-323-4578 (TTY: 711), 8 a.m. to 8 p.m., seven days a week. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

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