Our convenient code look up tool will instantly let you know if you need a pre-authorization for a specific procedure, medication or revenue code.
If an authorization is required for the requested procedure, to submit an authorization Login here.
Out-of-network providers must submit a pre-authorization for all procedures. Join Our Network
Please note: Certain services may not be covered. Please refer to the state specific benefit coverage and limitations, including behavioral health and long term care services, age/diagnosis-specific authorization requirements, and self-referral services.
|Behavioral Health, Home Health, DME, Dental, and Vision
Please contact Sunshine Health Plan for pre-authorization requirements.
Services by a non-participating facility or provider
|Type of service||Authorization Required?|
|Vision services by an optometrist or ophthalmologist are administered by Opticare||NO|
|Dental services administered by MCNA||NO|
|Services in an Public Health or Public Welfare Agency||NO|
|Family Planning services billed with a V25 through V25.9 diagnosis||NO|
|Emergency Room and Urgent Care Services||NO|
|Services by an anesthesiology provider (other than pain management) do not require pre-authorization||NO|
|Participating chiropractic services||NO|
|Services rendered in the home are administered by Univita.||YES|
Disclaimer: Code validation is not a guarantee of payment.