Wellcare by Meridian (AIP) Pre-Auth
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.
Use the tool below to verify prior authorization (PA). If an authorization is required, submit a request using the secure provider portal.
Please note: Pre-service reviews for certain services are supported by Meridian Plan vendor partners. See the Vendor Solutions table below for details.
All services for out-of-network providers require PA, except emergency care, out-of-area urgent care, or out-of-area dialysis.
LTSS providers, please contact the health plan for authorization requirements.
Answer these questions to get started:
Are Services being performed in the Emergency Department or Urgent Care Center or for Dialysis or hospice?
| Types of Services | YES | NO |
|---|---|---|
| Is the member being admitted to an inpatient facility? | ||
| Are anesthesia services being requested for pain management? | ||
| Is a non-par provider rendering services other than flu/pneumonia shots? |