HAVE AN ENROLLMENT NEED? SHOP OUR PLANS
Please be advised that we are currently experiencing longer than normal hold times when calling our Medical Management Department at 1-833-863-1310. The preferred method for submitting authorizationsis through the Secure Provider Portal at provider.ambetterofnorthcarolina.com. Once you submit your Prior Authorization request, the quickest method to check authorization status is through the Secure Provider Portal.
All attempts are made to provide the most current information on the Pre-Auth Needed Tool. A prior authorization is not a guarantee of payment. Payment may be denied in accordance with Plan’s policies and procedures and applicable law. 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.
Behavioral Health services need to be verified by Ambetter of North Carolina Inc.
Speech, Occupational and Physical Therapy need to be verified by NIA
Oncology/supportive drugs need to be verified by New Century Health.
NOTE: Services related to an authorization denial will result in denial of all associated claims.
Are services being performed in the Emergency Department, or for Emergent Transportation?
|Types of Services||YES||NO|
|Are services being performed or ordered by a non-participating provider?|
|Is the member being admitted to an inpatient facility?|
|Are anesthesia services being rendered for pain management or dental surgeries?|
|Is the member receiving hospice services?|
|Is the member receiving gender reassignment services?|