Medical, Dental & Pharmacy
- Medical
- Ambulatory Surgical Services
- Children's Services
- Chiropractic
- Clinic Services
- Community First Services and Supports (CFSS)
- Early Intensive Development and Behavioral Intervention (EIDBI)
- Equipment and Supplies
- HCBS
- Hearing Services
- Home Care Services
- Hospice Services
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Laboratory/Pathology, Radiology, and Diagnostic Services
- Language Interpreter Services
- Long-Term Care
- Medication Reconciliation
- Mental Health Services
- Optical Services
- Personal Care Assistance (PCA) Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitation Services
- Renal Dialysis
- Restricted Recipient Program
- School-Based Community Services
- Substance Use Disorder
- Telehealth Services
- Transportation
- Tribal and Federal Indian Health Services
- Dental
- Pharmacy
Authorization Requirements
Types of Transports Requiring Authorization
| Types of Transports | Descriptions |
| Out-of-state nonemergency transportation (NEMT) | Does not include origination or destination points located in neighboring states when the county of the neighboring state is contiguous to Minnesota.
PrimeWest Health must approve authorization of the out-of-state medical service and provide the authorization to the NEMT transport coordinator or provider.
The agency maintains documentation of the authorization by the local agency in the member’s file and it is not entered into the PrimeWest Health claims processing system.
Further review by PrimeWest Health may also be required. |
| NEMT Modes 4, 5, and 7 services | Any out-of-network NEMT requires authorization. |
Review the Service Authorization section for general authorization requirements.
Out-of-State Medical Services
NEMT providers considering requests for out-of-state medical transportation must obtain proof of authorization for out-of-state medical services from the member or responsible person. The PrimeWest Health transportation coordinator completes the assessment and authorization for out-of-state medical services. The out-of-state services must be approved by PrimeWest Health before transportation is approved.
Transportation of a Minor
Transports of minors age 17 and under require parental consent for transport if the parent or legal guardian is unable to accompany the minor. The signed Unaccompanied Minor Transport Form is valid for one year.
PW_11-19_597
Updated_04/25/2023
