Skip to Main Content

Attention Providers Affected by Hurricane Helene: If your organization is facing challenges due to Hurricane Helene and need assistance with medical, personal care, or specialized supplies, we are here to support you.  Please reach out to Carolina Complete Health as we are coordinating relief efforts for providers in the affected areas of Western North Carolina.  Click Here for More Information.

Carolina Complete Health Standard Plan Pre-Auth Tool

Tailored Plan Pre-Auth Tools

For Trillium physical health pre-auths, please see the Trillium Pre-Auth Check tool.

For Partners physical health pre-auths, please see the Partners Pre-Auth Check tool.

Behavioral Health UM Prior Authorization

For additional information related to Behavioral Health authorizations, please see the BH UM Prior Authorization Guidelines.

Pharmacy Prior Authorization

For Pharmacy or Medication related authorizations including:

  • Home Infusion Therapy
  • Physician Administer Drug Program
  • Outpatient Pharmacy Medication
Please refer to Pharmacy Webpage for More Information
DISCLAIMER: Your current browser's security settings does not allow the use of this tool. This tool requires the use of Internet Explorer 10 or Later. If you are currently using Internet Explorer as your browser and you see this message, you should try to update it or use another browser like Google Chrome or Firefox.
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 Envolve Vision.
Dental Services are administered by the State.  Please click here to verify.
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.

 

Are Services being performed in the Emergency Department or Urgent Care Center or Family Planning services billed with a Contraceptive Management diagnosis?

Types of Services YES NO
Is the member being admitted to an inpatient facility?
Are services being rendered for pain management?
Are oral surgery services being provided in the office?
Is the member receiving hospice services?

To submit a prior authorization Login Here.