Get Indiana Prior Authorization Request Form - Tobii

If you're a provider, call our Provider Hotline at 800-686-1516. If you're an Ohio Medicaid member, call our Consumer Hotline at 800-324-8680.

The Indiana Health Coverage Programs (IHCP) requires prior authorization (PA) for certain covered services to document the medical necessity for those services.

To be eligible for coverage, you must: Be a United States citizen or meet Medicaid citizenship requirements. Your local county Job and Family Services office can help to explain these requirements and can help get you enrolled. Have or get a Social Security number. Be an Ohio resident. Meet financial requirements.

Advanced Imaging Prior Authorization Ordering physicians must obtain prior authorization for the following outpatient, non-emergent diagnostic imaging procedures: MRI/MRAs. CT/CTA scans.

Please call 1-844-607-2831 to obtain prior authorization for emergency admissions.

All in-patient services require prior authorization. Please call 1-800-488-0134Navigate to tel:1-833-230-2101Navigate to tel:1-833-230-2101Navigate to tel:1-833-230-2101 to obtain prior authorization for emergency admissions. Outpatient emergency services do not require prior authorization.

The PA attachment allows a provider to document the clinical information used to determine whether or not the standards of medical necessity are met for the requested service(s).

Read the application carefully. Attach copies of your proof of income, resources (such as cash, savings, checking, real property, stocks, bonds, etc.), proof of citizenship or alien status, pregnancy if applicable, and other insurance you may have.