Authorization for Providing Services. The provider agreement directs the third party provider on how to obtain information that delineates the process the third party provider follows to receive authorization for providing services in the benefit package to members. The third party provider agrees to clearly specify authorization requirements to its providers and in any provider agreements with its providers. The Indian Health Care Provider (IHCP) shall ensure service authorization is given to the third party provider prior to the start date of designated services by the provider. When prior written authorization is not practicable, verbal authorization should be provided for the service and written authorization issued thereafter. Services provided on an emergency basis should be followed up with written confirmation of the service, when appropriate. Revised service authorizations shall be issued to third party providers promptly, with sufficient notice to allow third party providers to comply with the terms of the revised service authorization (for example, to prevent providers from unknowingly exceeding reduced authorized service units) and to timely submit accurate claims during the appropriate billing period.
Authorization for Providing Services. The subcontract directs the subcontractor on how to obtain information that delineates the process the subcontractor follows to receive authorization for providing services in the benefit package to members. The subcontractor agrees to clearly specify authorization requirements to its providers and in any sub- subcontracts. MCOs shall ensure service authorization is given to the provider prior to the start date of designated services by the provider. When prior written authorization is not practicable, verbal authorization should be provided for the service and written authorization issued thereafter. Services provided on an emergency basis should be followed up with written confirmation of the service, when appropriate. Revised service authorizations shall be issued to providers promptly, with sufficient notice to allow providers to comply with the terms of the revised service authorization (for example, to prevent providers from unknowingly exceeding reduced authorized service units) and to timely submit accurate claims during the appropriate billing period.
Authorization for Providing Services. The provider agreement directs the provider on how to obtain information that delineates the process the provider follows to receive authorization for providing services to members. The PO agrees to clearly specify authorization requirements to its providers and in any provider agreements with its providers. …
Authorization for Providing Services. The provider agreement directs the provider on how to obtain information that delineates the process the provider follows to receive authorization for providing services in the benefit package to members. The MCO agrees to clearly specify authorization requirements to its providers and in any provider agreements with its providers. MCOs shall ensure service authorization is given to the provider prior to the start date of designated services by the provider. When prior written authorization is not practicable, verbal authorization should be provided for the service and written authorization issued thereafter. Services provided on an emergency basis should be followed up with written confirmation of the service, when appropriate. Revised service authorizations shall be issued to providers promptly, with sufficient notice to allow providers to comply with the terms of the revised service authorization (for example, to prevent providers from unknowingly exceeding reduced authorized service units) and to timely submit accurate claims during the appropriate billing period.
