Medicaid/CHIP/STAR+PLUS Authorization Tool
DISCLAIMER: All attempts are made to provide the most current information on the Prior Authorization Search 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.
Non-participating providers in El Paso Health’s network must submit a prior authorization form for all services (some exceptions exist, see below).
Emergent services do not require prior authorization.
Inpatient services require notification within 24-hours of admission. Prior to submitting requests for the following services:
- Vision services need to be verified by Envolve Vision Services
- Dental services need to be verified by DentaQuest/MCNA
Medicaid Members: Family Planning services with a contraceptive management diagnosis do not require an authorization whether the Provider is In-Network or Out-of-Network.
CHIP Members: Family Planning services with a contraceptive management diagnosis are not a benefit.
THSteps checkups do not require an authorization whether Provider is In-Network or Out of Network.
List of Services that require Prior Authorization
Click on the link below to review the list of services that require prior authorization.
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Tarjeta de regalo de $25 para Walmart, para miembros menores de 18 años que acudan a una visita de seguimiento con el psiquiatra a más tardar 7 días de estar hospitalizado por un problema de salud mental. Los miembros pueden recibir una tarjeta de regalo al año.
Una tarjeta de regalo de $15 para los miembros de hasta 20 años que acudan a tiempo a un chequeo médico de Pasos Sanos de Texas.
