Services Requiring Preauthorization

DAKOTACARE requires certain procedures, services, or equipment to be preauthorized prior to coverage.  Members or providers should contact DAKOTACARE before services are provided to ensure they have been notified of an admission or provision of service in order that the Medical Necessity of the admission or service may be determined.

Below you will find the most current lists of services and durable medical equipment requiring preauthorization or items that are not covered.  These are subject to change at any time, so if you question whether preauthorization is necessary, please contact DAKOTACARE.

DAKOTACARE Services to be Preauthorized pdf (61k)

DAKOTACARE Durable Medical Equipment (DME) Preauthorization Requirements pdf (164k)

DAS Services to be Preauthorized pdf (63k)

DAS Durable Medical Equipment (DME) Preauthorization Requirements pdf (165k)

Durable Medical Equipment (DME) No Preauthorization Required pdf (188k)

Durable Medical Equipment (DME) Items Not Covered pdf (200k)

Services Requiring Notification

DAKOTACARE has implemented a notification system for specialized imaging services, including CT, MRI, PET scans and nuclear cardiology studies. Below, providers will find the notification form and instructions, as well as a list of CPT codes associated with specialized imaging services.

DAKOTACARE Specialized Imaging Notification Form pdf (113k)

CPT Code List for Special Imaging Notifications pdf (71k)

In you have any questions regarding services requiring preauthorization or notification, please feel free to call Customer Service at 605-334-4000 or 1-800-325-5598.  Customer Service will forward your call on those items that require Medical Management assistance.