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How do I get prior authorization for Express Scripts?

Please call us at 800.753. 2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

Why does pre-authorization happen?

Under medical and prescription drug plans, some treatments and medications may need approval from your health insurance carrier before you receive care. Prior authorization is usually required if you need a complex treatment or prescription. Coverage will not happen without it.

What is the process of a prior authorization?

Prior authorization\u2014sometimes called precertification or prior approval\u2014is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

How does pre-authorization work?

What is a pre-authorization? A pre-authorization is essentially a temporary hold placed by a merchant on a customer's credit card, and reserves funds for a future payment transaction. This hold typically lasts about five days, though this depends on your MCC (merchant classification code).

How can I speed up my prior authorization?

16 Tips That Speed Up The Prior Authorization Process Create a master list of procedures that require authorizations. Document denial reasons. Sign up for payor newsletters. Stay informed of changing industry standards. Designate prior authorization responsibilities to the same staff member(s).

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How long does Express Scripts prior authorization take?

If your physician's office calls with all relevant medical information including member name, member ID number, diagnosis and past medication history, we may be able to provide a prior authorization decision during the call. If the request is faxed, it may take up to 24 to 72 hours for a decision.

How do I get prior authorization from Express Scripts?

Please call us at 800.753. 2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

What does prior authorization mean at Express Scripts?

Prior authorization ensures that you get the prescription drug that is right for you and that is covered by your benefit. If it's determined that your plan doesn't cover the drug you were prescribed, you can ask your doctor about getting another prescription that is covered. You'll receive it for your plan's copayment.

How long does Express Scripts prior authorization take?

If your physician's office calls with all relevant medical information including member name, member ID number, diagnosis and past medication history, we may be able to provide a prior authorization decision during the call. If the request is faxed, it may take up to 24 to 72 hours for a decision.

Who does the pre-authorization?

Who is responsible for obtaining prior authorization? The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider.

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