Common use of Authorization of Services Clause in Contracts

Authorization of Services. a. The LME/PIHP shall determine medical necessity for those services requiring prior authorization as set forth in Controlling Authority, including DMA Clinical Coverage Policies.

Authorization of Services. a. The Except for unmanaged visits that do not require prior authorization, the LME/PIHP shall determine medical necessity for those services requiring prior authorization as set forth in Controlling Authority, including DMA Clinical Coverage Policies.