Prior authorization definition

Prior authorization means that we must approve the Services in advance in order for the Services to be covered.
Prior authorization means approval for the provision of a service or the delivery of goods from the department before the provider actually provides the service or delivers the goods;
Prior authorization means a decision by XxXxx, prior to the time a Health Care Service or other benefit is to be delivered, that the Health Care Services are Medically Necessary. Prior Authorization is sometimes called pre-authorization, prior approval or pre-certification. AvMed requires you or your Physician to obtain Prior Authorization for certain services and medications before you receive them to ensure that you receive the most appropriate treatment. Prior Authorization is not a promise that AvMed will cover the cost of such services or medications.

Examples of Prior authorization in a sentence

  • Prior authorization for medications is expanded by automatic renewal without clinical review, or time/quantity extensions.

  • Prior authorization is required for facility-based sleep tests, independent sleep clinic services, and inpatient sleep tests.

  • Prior authorization shall be requested at the time of initial submission of the plan of care or at any time the plan of care is substantially amended and shall be renewed with the department or the department’s designated review agent.

  • Prior authorization by CareFirst BlueChoice is required for air ambulance services only, except for Medically Necessary air ambulance services in an emergency.

  • Prior authorization is not required for services covered by Medicare.


More Definitions of Prior authorization

Prior authorization means a process implemented by the department of community health that conditions, delays, or denies the delivery of particular pharmaceutical services to medicaid beneficiaries upon application of predetermined criteria by the department or the department's agent for those pharmaceutical services covered by the department on a fee-for-service basis or pursuant to a contract for those services. The process may require a prescriber to verify with the department or the department's agent that the proposed medical use of a prescription drug being prescribed for a patient meets the predetermined criteria for a prescription drug that is otherwise covered under this act or require a prescriber to obtain authorization from the department or the department's agent before prescribing or dispensing a prescription drug that is not included on a preferred drug list or that is subject to special access or reimbursement restrictions.
Prior authorization or “Prior Authorized” means a system that requires a Provider to get approval from the CO-OP before providing non-emergency healthcare services to a Member for those services to be considered Covered Services. Prior Authorization is not an agreement to pay for a service.
Prior authorization means a function performed by EGID, or its designee, to review for medical necessity in identified areas of practice as defined at 7.1 of this Contract, prior to services being rendered.
Prior authorization means the local Aging and People with Disabilities or Area Agency on Aging office participates in the development of proposed nursing facility care plans to assure the facility is the most suitable service setting for the individual. Nursing facility reimbursement is contingent upon prior authorization.
Prior authorization means the process of obtaining prior approval as to the appropriateness of a service or medication. Prior authorization does not guarantee coverage.
Prior authorization or “Prior Authorized” means a system that requires a Provider to get approval from SHL before providing non-emergency healthcare services to an Insured for those services to be considered Covered Services. Prior Authorization is not an agreement to pay for a service.
Prior authorization means the process by which an enrollee or a provider obtains approval prior to the initiation or continuation of a service as to the appropriateness of a service. The contractor may require prior authorization as a condition of payment. Prior authorization of a mental health service shall be based on psychosocial necessity. Prior authorization of a substance abuse service shall be based on service necessity.