Medicaid Pre-Auth
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.
Vision Services authorized by Optometrist or Opthalmologist specialist need to be verified by Envolve Vision.
Dental Services need to be verified by LDH via MCNA.
Behavioral Health/Substance Abuse need to be verified by LHCC.
Pharmacy services need to be verified by accessing the Louisiana Medicaid Single PDL (Fee For Service and Managed Care Organizations) (PDF).
The following services need to be verified by Evolent: Speech, occupational & physical therapy; Complex Imaging, MRA, MRI, PET & CT scans; Musculoskeletal services for shoulder, hip, spine and knee surgery; Pain Management and Spinal Cord Stimulators. Chiropractic specialty providers are NOT managed by Evolent.
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, you can learn about Joining Our Network.
Prior Authorization at a Glance
Prior Authorization is NOT Required
The following services do NOT require prior authorization:
- Services rendered in an emergency room or urgent care center
- Services rendered by a public health or welfare agency
- Family planning services billed with a contraceptive management diagnosis
Prior Authorization IS Required
The following services REQUIRE prior authorization:
- Services rendered by an out out-of-network provider, with the exception of emergency and urgent care services
- Admission of a member to an inpatient facility
- Hospice services
- Anesthesia services for pain management or dental procedures.
- Services rendered at home, other than DME, orthotics, prosthetics, supplies and therapeutic injections
- Services rendered by a chiropractor
Prior Authorization Check
To submit a prior authorization Login Here