OMNIA Health Plans
SERVICES REQUIRING PRIOR AUTHORIZATION
The following services/supplies require prior authorization:
- Ambulance Air
- Artificial Insemination
- Complex Diagnostic X-Ray CAT Scan/MRI/MRA/ MRS/Pet Scan/Nuclear testing
- Cosmetic/Reconstructive Surgery
- Durable Medical Equipment
- Electroshock Therapy
- Facility-Inpatient
- Home Health Care
- Home Infusion Therapy
- Hospice
- Infertility Services
- Organ Transplant
- Private Duty Nursing
- Skilled Nursing Facility
The following require prior authorization only when rendered on an inpatient basis:
- Chemotherapy
- Cognitive Rehabilitation
- Dialysis Services (includes hemodialysis and peritoneal dialysis)
- Infusion Therapy
- Mental Health Care
- Occupational Therapy
- Physical Therapy
- Radiation Therapy
- Recreational Therapy
- Speech Therapy
- Substance Abuse
- TMJ Treatment (Surgical and Non-Surgical)
