Examples of Prior authorization in a sentence
Refer to the Prior Authorization Section for Prior Authorization requirements.
The Prior Authorization process and requirements are regularly reviewed and updated based on various factors including evidence-based practice guidelines, medical trends, Practitioner/Provider participation, state and federal regulations, and our policies and procedures.
Prior Authorization is a clinical evaluation process to determine if the requested Healthcare Service is Medically Necessary, a Covered Benefit, and if it is being delivered in the most appropriate healthcare setting.
Benefits may not be payable for services from Out-of-network Practitioners/Providers if you fail to obtain Prior Authorization.
The Contractor may require Prior Authorization in accordance with Section 5.I of this Contract for drugs outside the PDL.