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Some plans allow patients to file their own prior authorizations, but most often this is a process that must be initiated with the doctor's office. Often your doctor will have an idea if the healthcare you need is likely to require this extra step.
Prior authorization (also called \u201cpreauthorization\u201d and \u201cprecertification\u201d) refers to a requirement by health plans for patients to obtain approval of a health care service or medication before the care is provided. This allows the plan to evaluate whether care is medically necessary and otherwise covered.
Examples of the more common health care services that may require prior authorization include: Planned admission to a hospital or skilled nursing facilities. Surgeries. Advanced imaging, such as MRIs and CT scans. Transplant and donor services. Non-emergency air ambulance transport. Medical equipment.
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.
Definition of Authorization It is a legal obligation to ensure that the insurance payer pays for the specific medical service mentioned in the medical claim form. Without authorization, the insurance payer is free to refuse the payment of a patient's medical service as part of the health care insurance plan.
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Pre-authorization is step two for non-urgent or elective services. Unlike pre-certification, pre-authorization requires medical records and physician documentation to prove why a particular procedure was chosen, to determine if it is medically necessary and whether the procedure is covered.
A request from a health care provider to a health plan to obtain authorization for referring an individual to another health care provider.
1-855-270-2327 (TTY 711) 24 hours a day. 1-844-854-7272 (TTY 711) 24 hours a day. 1-888-522-1298 (TTY 711) 24 hours a day.
1-855-270-2327 (TTY 711) 24 hours a day. 1-844-854-7272 (TTY 711) 24 hours a day. 1-888-522-1298 (TTY 711) 24 hours a day.
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.

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