Get Prior Authorization Request Form Member Information ...

What is a prior authorization in healthcare? Although a lengthy process, the ultimate purpose of PA is to optimize patient outcomes by ensuring that they receive the most appropriate medication while reducing waste, error and unnecessary prescription drug use and cost, it is about keeping healthcare costs in check.

To obtain prior authorization, call the number on your ID card. This call starts the utilization review process.

Health care providers usually initiate the prior authorization request from your insurance company for you. However, it is your responsibility to make sure that you have prior authorization before receiving certain health care procedures, services and prescriptions.

Through Medicaid services, a referral is issued in writing by your primary care physician when he or she feels it is necessary for you to visit another health care provider for treatment or tests. A prior authorization for this referral is necessary in some cases.

A prior authorization (PA), sometimes referred to as a pre-authorization, is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.

How do I get a prior authorization? Your doctor will start the prior authorization process. Usually, they will communicate with your health insurance company. Your health insurance company will review your doctor's recommendation and then either approve or deny the authorization request.

Most payer-physician contracts prohibit charging such fees, but if the patient is out-of-network they (the physician) have no contractual relationship with the plan. ... Some specialists try to avoid prior authorizations by referring the patient back to the PCP to obtain a prior authorization.

The prior authorization process gives your health insurance company a chance to review how necessary a certain medication may be in treating your medical condition. ... During their review the insurance company may decide a generic or another lower cost alternative may work equally well in treating your medical condition.

How do I get a prior authorization? Your doctor will start the prior authorization process. Usually, they will communicate with your health insurance company. Your health insurance company will review your doctor's recommendation and then either approve or deny the authorization request.