Prior Authorization

Some covered services or medications may need approval from Meridian, this is called a Prior Authorization (PA). You do not need a paper referral from Meridian to see a provider, but your provider may need to request a prior authorization from Meridian for a service to be approved.

The recently passed Prior Authorization Reform Act is helping us make our services even better. This bill took effect January 1, 2022.

Our prior authorization process will see many improvements. We will be more clear with processes. And we will reduce wait times for things like tests or surgeries. You will also see improved fairness with our PA process.

Our current PA process is NCQA certified. It meets many of the new law's standards. However, we see this as a time to continue improving our services.

For clinical criteria, please see the information linked below. To request PA information or receive additional support, please contact us at memberservices.mi@centene.com or 888-437-0606 (TTY: 711).

Do I need a referral to see a specialist?

No, you do not need a referral from your PCP to see a specialist. You do not need a referral for routine vision care, chiropractic services, or mental health/counseling services.

Below is a list of services that require prior authorization from Meridian before your healthcare provider can proceed with treatment. 

Services that require a Prior Authorization Prior Authorization Required for some or all of the Services
Immunizations & Vaccines (shots) Some services may require prior authorization
Circumcisions Some services may require prior authorization
Birth Control Some items may require prior authorization
Obstetric and Maternity Care Some services may require prior authorization
Abortions Yes
Medical Inpatient Care Yes
Skilled Nursing Facility Yes
Inpatient Rehabilitation Yes
Long Term Acute Care Hospital Yes
Cardiac and Pulmonary Rehab Some services may require prior authorization
Home Health Care Yes
Specialty Care (Office Visits and Clinics) Yes
Diagnostic Testing Urinalysis and Urine Cultures Yes
Radiology Services (X-rays) Some services may require prior authorization
Rehabilitative/Habilitative Services and Devices Some services may require prior authorization
Hearing Aids Yes
Asthma Supplies Some items may require prior authorization
Prosthetics/Orthotics Some items may require prior authorization
Medical Supplies Some items may require prior authorization
Durable Medical Equipment (Wheelchairs, walkers, hospital beds, etc.) Some items may require prior authorization
Non-emergent, Inpatient, Ambulatory, Outpatient, Emergency and Reconstructive Surgeries Some services may require prior authorization
Transplants Yes
Hospice Care Yes
Eye Care and Eyeglasses Some services may require prior authorization
Diabetes Care Some services may require prior authorization
Prescription and Over the Counter (OTC) Drugs Some items may require prior authorization
Weight Management (WM) Yes
Pain Management Injections Some services may require prior authorization
Miscellaneous, unlisted, or no other specified procedures Yes
Specialty care (office visits and clinics) Some services may require prior authorization
Diagnostic Testing Urinalysis and Urine Cultures Some services may require prior authorization
Non-emergent Out of State Care Some services may require prior authorization