Prior-Auth Needed?

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 your Provider Manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.

Out-of-network providers must submit a pre-authorization for all services, excluding family planning, emergency room and table top x-ray service.

If you are not in the Louisiana Healthcare Connections provider network, please click Join Our Network for more information.

Vision Services need to be verified by Opticare.
Dental Services need to be verified by DHH.
Complex imaging, MRA, MRI and CT scans need to be verified by NIA.
Behavioral Health Services need to be verified by Magellan.
Outpatient Physical, Occupational and Speech Therapy Services need to be verified by Cenpatico STRS.
Pharmacy services need to be verified by US Script.

Emergency and Urgent Care Services do NOT require prior authorization.

Type of service Authorization Required?
The information below supersedes responses by the code lookup tool.
Inpatient Confinement YES
Anesthesia services for pain management or oral surgery YES
Plastic or oral surgeon services rendered in the office YES
Services rendered in the home (including Home IV Infusion and Home Health) YES
Family Planning services billed with a V25 through V25.9 diagnosis NO
FQHC, DOH and RHC NO

    If an authorization is required for the requested procedure, to submit an authorization Login here.