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Prior authorization (prior auth, or PA) is a management process used by insurance companies to determine if a prescribed product or service will be covered.
The prior authorization process can range from a few days to a few weeks. This can depend on the urgency of getting the medication, the speed of the provider and insurance communicating, and the complexity of completing all the required steps.
Private, for-profit plans often require Prior Authorization. Medicare Advantage (MA) plans also often require prior authorization to see specialists, get out-of-network care, get non-emergency hospital care, and more.
Prior authorization (prior auth, or PA) is a management process used by insurance companies to determine if a prescribed product or service will be covered.
You will also be required to provide proof of identity (such as a drivers license or state identification card), a Social Security Number (SSN), proof of residency in the state of Pennsylvania, proof of United States citizenship (some exceptions may apply), and information on your household composition.
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AmeriHealth Caritas Pennsylvania, a part of AmeriHealth Caritas, is a Medical Assistance (Medicaid) managed care health plan. Our mission is to help our members get care, stay well, and build healthy communities.
All out of network services (excluding ER and family planning) require prior authorization. PCPs should track receipt of consult notes from the specialist provider and maintain these notes within the patients medical record.
The provider may call the provider inquiry unit to request information on the authorization or to check the status of a request. In either scenario, the number to call is 1-800-537-8862.

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