Prior Authorization and Verification, Standing Referrals, and No Financial Disincentives Clause Samples

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Prior Authorization and Verification, Standing Referrals, and No Financial Disincentives. (1) Prior Authorization and Verification. Contractor is solely responsible for obtaining any required prior authorization from RME for services, treatments or procedures ordered or recommended by Contractor. The Covered Person shall not have this responsibility. If prior authorization from RME is required for a particular service provided to a Covered Person, such prior authorization will only be issued by RME in writing. If Contractor desires to verify the eligibility of a Covered Person or obtain information regarding the benefits under a Covered Person’s Health Care Plan, Contractor can telephone RME or use on-line eligibility as available to receive such information. Such verification, however, does not constitute prior authorization.
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