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What is a referral authorization?

A request from a health care provider to a health plan to obtain authorization for referring an individual to another health care provider.

How do I submit a prior authorization to Medi-Cal?

Pharmacy providers and prescribers can submit a PA request via fax by utilizing the following approved forms: 50-1, 50-2, 61-211, or the Medi-Cal Rx PA Request Form, available January 1, 2022, in Reference Materials at .

Does Medi-cal require authorization?

Providers must receive authorization from Medi-Cal in order to provide and/or be paid for some of these services. The form a provider uses to request authorization is called a Treatment Authorization Request (TAR). Your Medi-Cal provider will know how and when to complete and submit a TAR.

What does it mean when a drug needs prior authorization?

What is prior authorization? This means we need to review some medications before your plan will cover them. We want to know if the medication is medically necessary and appropriate for your situation. If you dont get prior authorization, a medication may cost you more, or we may not cover it.

What is difference between referral and authorization?

A referral is an order from your PCP to see a specialist or receive certain medical services from some providers. Your PCP helps make the decision about whether specialist services are necessary for you. Prior authorization is approval from the health plan before you get a service or fill a prescription.

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