Prior authorization is advanced approval of specific procedures, services, medical devices, supplies, and medications by a patient’s health plan. Prior authorization review is the process to determine medical necessity of said services accordingly to clinical care guidelines and utilization management criteria.
Prior Authorization is required for all scheduled (planned) inpatient admissions, and certain predetermined services, medical pharmaceuticals, surgical, diagnostic, therapy and imaging procedures.
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).
