Documentation to support medical necessity must be submitted with Prior Authorization requests. This information supports the need for the treatment and submitting detailed information on initial submission helps to ensure the request can be processed in a timely manner.
Examples of appropriate documents include:
- Current history and/or physician examination notes that address the problem and need
for services requested - Relevant lab and/or radiology results
- Relevant specialty consultation notes
- Other pertinent information to aid in decision making process
CHPW Utilization Management staff may request specific additional clinical information via fax or
telephonically to complete the authorization process.
What kind of care do you need? Not every medical issue needs emergency care. If you have a medical issue that doesn’t seem to be life-threatening, but you’re not sure what to do, you can call our Nurse Advice Line for help. They can help you decide if you should see a primary or urgent care doctor. The Nurse Advice Line is free and available 24/7 for members at 1-866-418-2920 (TTY Relay: 7-1-1).
