Medicaid Pre-Auth
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.
Applied Behavioral Analysis (ABA) prior authorizations need to be submitted to, and verified by, Magellan Health; Fax: 888-656-5703
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.
Complex imaging, MRA, MRI and CT scans need to be verified by Evolent.
Behavioral Health/Substance Abuse need to be verified by LHCC.
Outpatient Physical, Occupational and Speech Therapy Services need to be verified by Evolent.
IPM, Spinal Cord Stimulators and MSK need to be verified by Evolent.
Pharmacy services need to be verified by accessing the Louisiana Medicaid Single PDL (Fee For Service and Managed Care Organizations) (PDF).
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 anesthesia services being rendered for pain management or dental surgery? | ||
| Are plastic or oral surgeon services being rendered in the office? |