Common use of Services Needing Prior Approval or Notification Clause in Contracts

Services Needing Prior Approval or Notification. Some services require Prior Approval or review of clinical documentation before Benefits will be provided by the Plan. Some services require that we be notified that you have received services. If you have any questions or need assistance to determine which services require Prior Approval or notification, please visit xxx.xxxxxxxxxxxxx.xxx or call Member Services at 1-855-624-6463 (TTY/TDD: 711). When receiving services from a non-Network Provider, if you fail to obtain Prior Approval for a service requiring Prior Approval, or if you fail to submit timely notification for a service that requires notification, you may not receive Benefits for that service and you may be responsible for the full cost of the service.

Services Needing Prior Approval or Notification. Some services require Prior Approval or review of clinical documentation before Benefits will be provided by the Plan. Some services require that we be notified that you have received services. If you have any questions or need assistance to determine which services require Prior Approval or notification, please visit xxx.xxxxxxxxxxxxx.xxx or call Member Services at 1-855-624-6463 (TTY/TDD: 711)Services. When receiving services from a non-Network non‐Network Provider, if you fail to obtain Prior Approval for a service requiring Prior Approval, or if you fail to submit timely notification for a service that requires notification, you may not receive Benefits for that service and you may be responsible for the full cost of the service.