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Why do we need 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 don't get prior authorization, a medication may cost you more, or we may not cover it.

What does medical group mean?

A medical group/IPA is a network of independent doctors who own and operate their own practices (instead of being salaried employees of a larger healthcare system). These doctors join a medical group so they can stay independent while getting the support they need to take care of patients.

What is the prior authorization process?

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.

What is included in the release of patient information?

The patient's legal name, date of birth, gender, Social Security number, address, telephone number, guarantor, subscriber, or next-of-kin are key identifying elements that assist in establishing the proper individual.

What is authorization to release health information?

An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

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