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
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.