YouthCare Prior 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 the 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 Meridian.
Dental Services need to be verified by Envolve Dental.
Complex imaging, Speech, Occupational and Physical Therapy, MRA, MRI, PET, and CT scans need to be verified by Evolent.
Non-Emergent Non-Ambulance Transportation must be verified by MTM
All contracted and non-contracted providers, please review the Prior Authorization tool. Prior authorization will be based on YouthCare payment guidelines for services. For non-contracted providers who would like to join the YouthCare network, visit the Join Our Network page.
Would this be Emergency or Urgent Care, Facility Based Dialysis, FQHC, DOH, RHC or are these 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 procedures? | ||
| Are chiropractic services being rendered after the 12th visit? | ||
| Are services, other than DME, orthotics, prosthetics, and supplies, being provided in the home? | ||
| Are hospice services being provided? |