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 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/Substance Abuse need to be verified by Cenpatico.
Outpatient Physical, Occupational and Speech Therapy Services need to be verified by NIA.
Pharmacy services need to be verified by US Script.
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.
Are Services being performed in the Emergency Department or Urgent Care Center or FQHC, DOH, RHC, Family Planning services billed with a contraceptive management diagnosis?
|Types of Services||YES||NO|
|Is the member being admitted to an inpatient facility?|
|Are services, other than DME, orthotics, prosthetics, and supplies, being rendered in the home?|
|Are anesthesia services being rendered for pain management or dental surgery?|
|Are plastic or oral surgeon services being rendered in the office?|