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

The Board shall provide a Family Coverage program of prescription insurance based upon the following co-pay amounts: Retail Home Delivery (90-day supply) Generic $10 $20 Formulary $30 $60 Non-Formulary $60 $120 Specialty $100 $200 Step Therapy, Preferred Specialty Management, and Prior Authorization with additions shall be in effect.
The prescribing Physician shall provide CalOptima with all information necessary to process Prior Authorization requests.

More Definitions of Prior authorization

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 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 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 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 process of obtaining prior approval as to the appropriateness of a service or medication. Prior authorization does not guarantee coverage.

Prior authorization means the approval process used by a carrier before certain drug benefits may