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)