Preauthorization. Preauthorization, the pretreatment review by Blue Shield or Health Plan of a treatment plan and/or treatment site, is a contractual obligation under the terms of the Administrative Requirements and certain Member Plan Documents. Preauthorization must be requested prior to the initiation of certain services in accordance with the Member’s Plan Documents. Blue Shield or Health Plan may require certain clinical records and diagnostic aids relating to a Member to be included with requests for preauthorization. Charges for services rejected because Provider failed to initiate or receive preauthorization shall not be collected from the Member.
Appears in 3 contracts
Sources: Professional Provider Agreement, Participating Provider Agreement, Participating Provider Agreement