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Pre-Auth Check Tool | Ambetter of Illinois
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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
Vision services including any services rendered by an Optician, Optometrist or Ophthalmologist need to be verified by Envolve Vision
Dental services need to be verified by Envolve Dental
Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA
Musculoskeletal Services need to be verified by Turning Point
Oncology/supportive drugs for members age 18 and older need to be verified by New Century Health
Speech, Occupational and Physical Therapy need to be verified by NIA. For Chiropractic providers, no authorization is required.
Post-acute facility (SNF, IRF, and LTAC) prior authorizations need to be verified by CareCentrix ; Fax 877-250-5290
The following Substance Use disorder services require Notification of Admission within 1-Business Day: Residential Treatment services (ASAM Level 3.1-3.5), Partial Hospitalization Program (PHP) (ASAM Level 2.5), Intensive Outpatient Program (IOP) (ASAM Level 2.1)
Services provided by Out-of-Network providers are not covered by the plan. Join Our Network
Are Services being performed in the Emergency Department?
|Types of Services||YES||NO|
|Are the services 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?|