Prior Authorization
TrueCare evaluates prior authorization requests based on medical necessity, medical appropriateness, and benefit limits.
Covered Services and Prior Authorization Requirements
Please note – covered services and prior authorization requirements may differ between MississippiCAN and CHIP.
View The Prior Authorization List
Please refer to the Procedure Code Lookup Tool to check whether a service requires prior authorization. All services that require prior authorization from TrueCare should be authorized before the service is delivered. TrueCare is not able to pay claims for services in which prior authorization is required, but not obtained by the provider.
Prior Authorization Submission Options
| Method | Contact Info |
|---|---|
Provider Portal (Preferred) | The provider portal is the fastest method to request prior authorization for health care services. You can receive immediate approval and also review the status of an authorization. |
Phone | |
Fax | 1-937-396-3677 |
TrueCare |
Non-Participating Providers
Prior authorization must be obtained before sending patients to non-participating providers, with the following exceptions:
Emergency Services
All in-patient services require prior authorization. Please call 1-833-230-2174 to obtain prior authorization for emergency admissions. Outpatient emergency services do not require prior authorization.
Prior authorization is not required for coverage of post-stabilization services when these services are provided in any emergency department or for services in an observation setting by a participating provider.
To request prior authorization for observation services as a non-participating provider or to request authorization for an inpatient admission, please call 1-833-230-2174 and follow the appropriate menu prompts. During regular business hours, your call will be answered by our Utilization Management department.
Please call 1-833-230-2174 for any questions related to post-stabilization services.
Pharmacy Prior Authorization
Some drugs may require prior authorization before they will be covered. Please refer to the Pharmacy page to review these requirements.
For drugs processed through Gainwell Technologies | Refer to Formulary or Preferred Drug List on the Drug Formulary page |
For drugs processed through the medical benefits | Refer to the Procedure Code Lookup Tool |
Dental Prior Authorization
Medicaid dental providers can submit a dental authorization request via the Avesis Portal.
Advanced Imaging Prior Authorization
Ordering physicians must obtain prior authorization for the following outpatient, non-emergent diagnostic imaging procedures:
- MRI/MRAs
- CT/CTA scans
- PET scans
Ordering providers can obtain prior authorization from from Evolent, formerly known as NIA, for imaging procedures at RadMD’s website.
TurningPoint Partnership for Cardiac and Musculoskeletal Surgical Procedures
TrueCare partners with TurningPoint to cover Cardiac and Musculoskeletal Services for our TrueCare members.
Please refer to the Procedure Code Lookup Tool to check whether a service requires prior authorization from TurningPoint.
| TrueCare TurningPoint Contact Information | |||
|---|---|---|---|
| Local Phone | Toll Free Phone | Local Fax | Toll Free Fax |
| 601-608-7061 | 855-704-4201 | 601-533-4861 | 833-591-5291 |
Learn more information by visiting the TurningPoint website.