Preauthorization. Preauthorization, the pretreatment review by Highmark or Health Plan of a treatment plan, service, and/or treatment site, is a contractual obligation under the terms of the Member Plan Documents. Preauthorization must be requested prior to the initiation of certain services in accordance with the Member’s Plan Document. Highmark or Health Plan may require certain clinical records and diagnostic aids relating to a Member to be included with requests for preauthorization and Professional Provider agrees to provide such information in a timely manner. Charges for services denied because Professional Provider failed to initiate or receive preauthorization may not be collected from the Member. Appeal processes applicable to the Member may be Professional Provider’s only recourse.
Appears in 2 contracts
Sources: Highmark Professional Agreement, Highmark Professional Agreement