PA Health & Wellness (Community HealthChoices)
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.
Behavioral Health/Substance Abuse need to be verified by the respective Behavioral Health MCO
Non-participating providers must submit Prior Authorization for all services.
Effective 11-1-2020, Musculoskeletal Surgical Services Need to Be Verified by TurningPoint. Please contact TurningPoint by phone at 855-909-8222 or by fax at 717-303-5072.
Are Services being performed in the Emergency Department or Urgent Care Center, for Dialysis Service 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 anesthesia services being rendered for pain management or Dental services?|
|Are oral surgery services being provided in the office?|
|Are services, other than DME, orthotics, prosthetics, and supplies, being rendered in the home?|
|Is the member receiving hospice services?|
|Are services being rendered by a Chiropractor?|