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 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 Centene Vision Services.
Dental Services need to be verified by Centene Dental Services.
Complex imaging, MRA, MRI, PET, and CT scans need to be verified by Evolent.
Non-participating providers must submit Prior Authorization for all services.
For non-participating providers, Join 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
CMS Interoperability & Prior Authorization Final Rule: CY2025 Prior Authorization Requirements Reports and Metrics Summaries
In accordance with the Centers for Medicare & Medicaid Services (CMS) Final Rule (CMS 0057 F), we are annually publishing our prior authorization requirements and performance metrics to promote transparency, accountability, and better support our members and providers.
Reports:
- Nebraska Total Care CMS Final Rule 0057-F Prior Authorization Requirements (PDF)
- Nebraska Total Care Prior Authorization Metrics Summary (PDF)
The data presented in these publications reflects prior authorization requests processed during the applicable measurement year in accordance with CMS reporting specifications. Metrics are calculated using CMS defined methodologies and may not be directly comparable to alternative reports or third party summaries.
Norma Final de Interoperabilidad y Autorización Previa de los CMS: Resúmenes de Informes y Métricas sobre los Requisitos de Autorización Previa para el Año Calendario 2025
De conformidad con la Norma Final de los Centros de Servicios de Medicare y Medicaid (CMS) (CMS 0057 F), publicamos anualmente nuestros requisitos de autorización previa y métricas de desempeño con el fin de promover la transparencia y la rendición de cuentas, así como para brindar un mejor apoyo a nuestros miembros y proveedores.
Informes:
- Nebraska Total Care Norma Final 0057-F de los CMS: Requisitos de autorización previa: 112 (PDF)
- Nebraska Total Care Resumen de métricas de autorización previa: 112 (PDF)
Los datos presentados en estas publicaciones reflejan las solicitudes de autorización previa procesadas durante el año de medición aplicable, de conformidad con las especificaciones de presentación de informes de los CMS. Las métricas se calculan utilizando metodologías definidas por los CMS y podrían no ser directamente comparables con informes alternativos o resúmenes de terceros.