PRIOR AUTHORIZATION for ANESTHESIA SERVICES 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Section I: PATIENT INFORMATION. Fill in the patient's name, date of birth, age, and PEHP ID number accurately.
  3. Proceed to Section II: PROVIDER INFORMATION. Enter the date requested, ordering provider's details including contact person, NPI number, and phone/fax numbers.
  4. In Section III: PRE-AUTHORIZATION REQUEST, specify the requested dates of service and select the nature of request (e.g., Pre-Authorization).
  5. Indicate the primary diagnosis using ICD-10 codes and select the type of anesthesia requested from the provided options.
  6. Complete additional fields regarding place of service, estimated anesthesia time, and list all requested procedures with corresponding CPT/HCPCS codes.
  7. Finally, review your entries for accuracy before submitting. Ensure all necessary patient chart notes are included.

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Anesthesia itself does not require prior authorization; however, prior authorization may be required for the related surgical procedure or service.
Required Authorization means any registration, filing, declaration, application or notice to or with any person and any consent, approval, permit, qualification, waiver, waiting period, authorization, Order or action of or by any person.
Prior authorization requires your doctor or provider to obtain approval from your health plan before providing health care services or prescribing prescription drugs. Without prior authorization, your health plan may not pay for your treatment or medication. (Emergency care doesnt need prior authorization.)
This means the plan does not require prior authorization or premedical review. In these cases, it is going to be up to the physician or physician practice to decide if the patient meets the payor guidelines per local coverage determination policies.
Standard prior authorization requests typically take 1 to 3 business days, while urgent or expedited requests can be processed within 24 to 72 hours. Prior authorization is a critical checkpoint in healthcare, designed to ensure that treatments and medical services are medically necessary and cost-effective.
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Prior authorization is a way for insurance companies to review the medical service, procedure, item, or medication requested and make sure that its necessary for your care. Examples of services or procedures for which prior authorization may be needed include: admission to a hospital or skilled nursing facility.
A pre-authorization is a restriction placed on certain medications, tests, or health services that require your doctor to first check and be granted permission before your plan will cover the item.

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