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HAVE AN ENROLLMENT NEED? SHOP OUR PLANS
-
Our Health Plans
show Our Health Plans menu
-
- About Our Plans
- Our Benefits
- My Health Pays Rewards®
- Coverage Area Map
- Ways to Save
- What is Ambetter Health?
- Shop and Compare Plans
- Find a Doctor
Use your ZIP Code to find your personal plan.
- See coverage in your area
- Find doctors and hospitals
- View pharmacy program benefits
- View essential health benefits
Find and enroll in a plan that's right for you.
-
-
Join Ambetter Health
show Join Ambetter Health menu
-
- Four easy steps is all it takes
- What you need to enroll
- Special Enrollment Information
-
-
For Members
show For Members menu
-
- Pay Now
- Find a Doctor
- Drug Coverage
- Forms and Materials
- Ways to Pay
- New Members
- Renew Your Plan
- Better Health Center
- The Better Bulletin
- Member News
- Health Savings Account
- Medicare Eligible
Find everything you need in the member online account
- View your claims
- Review your plan benefits
- Print your ID card
- View rewards points total
-
Pre-Auth Check Tool | Ambetter from SilverSummit HealthPlan
Pre-Auth Needed?
All attempts are made to provide the most current information on the Pre-Auth Needed Tool. A prior authorization is not a guarantee of payment. Payment may be denied in accordance with Plan’s policies and procedures and applicable law. 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.
High Tech Imaging services are handled by NIA.
Behavioral Health services are handled by Silver Summit Health Plan.
Musculoskeletal Surgical Services need to be Verified by TurningPoint.
Speech, Occupational and Physical Therapy need to be verified by NIA. For Chiropractic providers, no authorization is required.
Effective 11/1/2023, identified Oncology Biopharmacy drugs need to be verified by New Century Health.
Services provided by Out-of-Network providers are not covered by the plan. Join Our Network.
NOTE: Services related to an authorization denial will result in denial of all associated claims.
Are services being performed in the Emergency Department, or for Emergent Transportation?
Services being performed in the Emergency Department do NOT require prior authorization
Types of Services | YES | NO |
---|---|---|
Are services being performed or ordered by a non-participating provider? | ||
Is the member being admitted to an inpatient facility? | ||
Are anesthesia services being rendered for dental surgeries? | ||
Is the member receiving gender reassignment services? |