Provider Toolkit: Prior Authorization Guide

Pre-Auth Needed Tool Use the Pre-Auth Needed Tool on Ambetter.MagnoliaHealthPlan.com to quickly determine if a service or procedure requires prior authorization.

Submit Prior Authorization

If a service requires authorization, submit via one of the following ways:

SECURE WEB PORTAL
provider.magnoliahealthplan.com
This is the preferred and fastest method.

PHONE
1-877-687-1187
After normal business hours and on holidays, calls are directed to the plan’s 24-hour nurse advice line. Notification of authorization will be returned by phone, fax or web.

FAX
Medical and Behavioral Health
1-855-300-2618

See below for a list of services that require prior authorization.

Emergency services DO NOT require prior authorization.
All out-of-network services and providers DO require prior authorization.
Failure to complete the required authorization or notification may result in a denied claim.

Services and Procedures Requiring Prior Authorization

THE FOLLOWING LIST IS NOT ALL-INCLUSIVE

Air ambulance transport (non-emergent fixed wing airplane)
Durable Medical Equipment (DME)
Home healthcare services
Hospice
Furnished medical supplies
Orthotics/prosthetics
Genetic testing
Quantitative urine drug screen

Reconstructive surgery
Experimental or investigational
High Tech Imaging administered by NIA (CT, MRI, PET):
- Submit requests to RadMD.com
- All inpatient admissions (within 1 business day of admission)
- Observation stays exceeding 48 hours
  - Notification is required within 1 business day if admitted
  All elective/scheduled admission notifications requested at least 5 days prior to the scheduled date of admit including but not limited to:
  - Medical admissions
  - Surgical admissions
  - Hospice care
  - Rehabilitation facilities
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  Ambetter from Magnolia Health is underwritten by Ambetter of Magnolia Inc. which is a Qualified Health Plan issuer in the Mississippi Health Insurance Marketplace. This is a solicitation for insurance. ©2024 Ambetter of Magnolia Inc., Ambetter.MagnoliaHealthPlan.com. If you, or someone you’re helping, have questions about Ambetter from Magnolia Health, and are not proficient in English, you have the right to get help and information in your language at no cost and in a timely manner. If you, or someone you’re helping, have an auditory and/or visual condition that impedes communication, you have the right to receive auxiliary aids and services at no cost and in a timely manner. To receive translation or auxiliary services, please contact Member Services at 1-877-687-1187 (Relay 711). For more information on your right to receive an Ambetter from Magnolia Health plan free of discrimination, or your right to receive language, auditory and/or visual assistance services, please visit AmbetterHealth.com and scroll to the bottom of the page.