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Pre-Auth Needed? | Ambetter de Peach State Health Plan
For the best experience, please use the Pre-Auth tool in Chrome, Firefox, or Internet Explorer 10 and above.
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 all services rendered by an Optometrist need to be verified by Envolve Vision
Dental services need to be verified by Envolve Dental
Behavioral Health/Substance Abuse need to be verified by Peach State Health Plan
Home Health and Durable Medical Equipment need to be verified by Peach State Health Plan
The following services (identifiable by procedure code search) need to be verified by Evolent: Complex Imaging, MRA, MRI, PET, and CT scans; Pain Management and Spinal Cord Stimulators; Speech, Occupational and Physical Therapy (excluding chiropractor specialty providers – no authorization required); Effective for dates of service 1/1/2024 forward, Musculoskeletal services for the spine, shoulder, hip and knee.
Oncology Biopharmacy and Radiation Oncology drugs need to be verified by New Century Health.
Post-acute facility (SNF, IRF, and LTAC) prior authorizations need to be verified by CareCentrix Fax: 877-250-5290. Swing Bed authorizations should be authorized by Ambetter from Peach State Health Plan.
Services provided by Out-of-Network providers are not covered by the plan. Join Our Network
Note: Services related to an authorization denial will result in denial of all associated claims.
Are Services being performed in the Emergency Department?
|Types of Services
|Are the services being performed or ordered by a non-participating provider (professionals/facilities)?
|Is the member being admitted to an inpatient facility?
|Are anesthesia services being rendered for dental surgeries?
|Are oral surgery services being provided in the office?
|Is the member receiving Gender Reassignment services?