YouthCare Prior 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 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.
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