Prior Authorization Review definition

Prior Authorization Review also referred to as “precertification” or “prior approval” is a process by which Physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
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Examples of Prior Authorization Review in a sentence

  • This amount shall not be eligible for later consideration as an unreimbursed expense under any benefit section of this Certificate nor can it be applied to your out-of-pocket expense limit, if applicable to this Certificate.OUTPATIENT SERVICE PRIOR AUTHORIZATION REVIEWOutpatient Service Prior Authorization Review is not a guarantee of benefits.

  • Prior Authorization Review Panel (PARP) — A panel of representatives from within the Department who have been assigned organizational responsibility for the review, approval and denial of PH-MCO Prior Authorization policies and procedures.

  • OTC — Over-the-Counter OUD-XXX — Opioid Use Disorder Centers of Excellence P&T — Pharmacy & Therapeutics PAHP — Prepaid Ambulatory Health Plan PARP — Prior Authorization Review Panel.

  • Prior Authorization Review Panel (PARP) — A panel of representatives from within the Department who have been assigned organizational responsibility for the review, approval and denial of all PH-MCO Prior Authorization policies and procedures.

  • You are responsible for obtaining Prior Authorization Review when required.

  • The PH-MCO’s submission of new or revised policies and procedures for Prior Authorization Review Panel (PARP) review and approval shall not act to void any existing policies and procedures that were already prior approved for operation in a HealthChoices Zone.

  • This amount shall not be eligible for later consideration as an unreimbursed expense under any benefit section of this Policy nor can it be applied to your out-of-pocket expense limit, if applicable to this Policy.OUTPATIENT SERVICE PRIOR AUTHORIZATION REVIEWOutpatient Service Prior Authorization Review is not a guarantee of benefits.

  • You can obtain Prior Authorization Review by contacting us at: Company: Seton Health Plan, dba: Dell Children’s Health Plan Address: [0000 Xxxxxxxxx Xx., Suite #305] [Austin, TX 78723] Phone: [0-000-000-0000 (TTY: 000-000-0000)] Fax: [000-000-0000] Email: [XXX-Xxxxxxxxxxxxx@xxxxxxxxx.xxx] Prior authorization is not a guarantee that benefits will be payable.

  • If a setting, service, treatment, supply, device, or prescription drug is listed below, Prior Authorization Review must be obtained before incurring any claims for that setting, service, treatment, supply, device, or prescription drug.

  • Utilization Management Program Benefits due to Insureds are subject to the following Utilization Management: Prior Authorization Review is intended to confirm the Medical Necessity and Medical Appropriateness of a setting, service, Treatment, supply, device, or Prescription Drug.

Related to Prior Authorization Review

  • Prior authorization means that we must approve the Services in advance in order for the Services to be covered.

  • Federal work authorization program means any of the electronic verification of work authorization programs operated by the United States Department of Homeland Security or any equivalent federal work authorization program operated by the United States Department of Homeland Security to verify information of newly hired employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), D.L. 99-603.

  • Work Authorization or "WA" means Buyer’s authorization in either electronic or tangible form for Supplier to conduct transactions under this Agreement in accordance with the applicable SOW (i.e., a purchase order, xxxx of lading, or other Buyer designated document). A SOW is a WA only if designated as such in writing by Buyer.

  • Product Authorizations means any and all approvals, including applicable supplements, amendments, pre- and post-approvals, clearances, licenses, notifications, registrations, certifications or authorizations of any Governmental Authority, any Standard Body necessary for the manufacture, development, distribution, use storage, import, export, transport, promotion, marketing, sale or other commercialization of a Product in any country or jurisdiction.

  • Marketing Authorization Application or “MAA” means an application for Regulatory Approval in a country, territory or possession.

  • Application Review Start Date means the later date of either the date on which the District issues its written notice that the Applicant has submitted a completed Application or the date on which the Comptroller issues its written notice that the Applicant has submitted a completed Application and as further identified in Section 2.3.A of this Agreement.

  • Service Authorization Request means a Provider’s or Enrollee’s request to the Contractor for the provision of a service.

  • Drug utilization review means an evaluation of a prescription drug order and patient records for

  • Authorization Form means a form specified in s. 440.73.

  • IRB approval means the determination of the IRB that the research has been reviewed and may be conducted at an institution within the constraints set forth by the IRB and by other institutional and federal requirements.

  • Utilization review means the prospective (prior to), concurrent (during) or retrospective (after) review of any service to determine whether such service was properly authorized, constitutes a medically necessary service for purposes of benefit payment, and is a covered healthcare service under this plan. WE, US, and OUR means Blue Cross & Blue Shield of Rhode Island. WE, US, or OUR will have the same meaning whether italicized or not. YOU and YOUR means the subscriber or member enrolled for coverage under this agreement. YOU and YOUR will have the same meaning whether italicized or not.

  • Marketing Authorization means all approvals from the relevant Regulatory Authority necessary to market and sell a Product in any country (including without limitation, all applicable pricing and governmental reimbursement approvals even if not legally required to sell Product in a country).

  • Compliance Review means an inspection of the home, grounds, and files to determine compliance with these regulations.

  • Service Authorization means that Open Ecosystem Partner needs to meet specific qualification requirements for the products included in a “Service” Product Family that Open Ecosystem Partner wants to promote and offer Services for as set out in detail in the Open Ecosystem Program Guide.

  • ACH Authorization means the ACH Debit Authorization Agreement in substantially the form of Exhibit H.

  • Approval Application means a BLA, NDA or similar application or submission for a Product filed with a Regulatory Authority in a country or group of countries to obtain marketing approval for a biological or pharmaceutical product in that country or group of countries.

  • Sell Authorization means that Distributor needs to meet specific training and qualification requirements for each product included in an “On Premise” Product Family that Distributor wants to resell as set out in detail in the Distributor Program Guide and the applicable RSPI.

  • Free appropriate public education means special education and related services that:

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Utilization review plan or "plan" means a written procedure for performing review.

  • Peer-reviewed medical literature means a scientific study published only after having been critically

  • Final Approval Order means the entry of the order and final judgment approving the Settlement Agreement, implementing the terms of this Settlement Agreement, and dismissing the Class Action with prejudice, to be proposed by the Settling Parties for approval by the Court, in substantially the form attached as Exhibit D hereto.

  • Disclosure Statement Approval Order means the Final Order approving, among other things, the adequacy of the Disclosure Statement pursuant to section 1125 of the Bankruptcy Code.

  • CPUC Approval means a final and non-appealable order of the CPUC, without conditions or modifications unacceptable to the Parties, or either of them, which contains the following terms:

  • Regulatory Approval Application means any application submitted to an appropriate Regulatory Authority seeking any Regulatory Approval.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.