{"component": "definition", "props": {"groups": [{"samples": [{"hash": "hyAWQBfxGMi", "uri": "https://choose.kaiserpermanente.org/content/dam/kp/secondsales/microsites/contents/pdf/lausd/LAUSD_EOC_Early%20Retirees_HI_2024.pdf", "label": "choose.kaiserpermanente.org", "score": 16.9398231506, "published": false}, {"hash": "aKhQ5DzBhUD", "uri": "https://sonomacounty.ca.gov/Main%20County%20Site/Administrative%20Support%20&%20Fiscal%20Services/HR/Divisions%20&%20Units/Benefits/Documents/EOC's/Kaiser/KP%20Hawaii%20HMO%20EOC.pdf", "label": "sonomacounty.ca.gov", "score": 16.3716716766, "published": false}, {"hash": "5LoGfSXUoGk", "uri": "https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/health-plan-documents/eoc/hi/sg/2025/platinum-0-20-rx-ded-dental-1095-hi-en.pdf", "label": "healthy.kaiserpermanente.org", "score": 15.1718254089, "published": false}], "snippet": "means that we must approve the Services in advance in order for the Services to be covered.", "size": 132, "snippet_links": [{"key": "in-advance", "type": "clause", "offset": [40, 50]}, {"key": "services-to-be", "type": "clause", "offset": [68, 82]}], "hash": "2c47bfab30d532c516edeba8b7d0b3c7", "id": 1}, {"samples": [{"hash": "35PFlXchpWW", "uri": "https://portal.ct.gov/-/media/sots/regulations/notices_of_intent/noi2013112901pdf.pdf?la=en", "label": "Notice", "score": 10.9548254013, "published": false}, {"hash": "2YsT1lv9ios", "uri": "https://eregulations.ct.gov/eRegsPortal/Browse/getDocument?guid=%7BD0AFCA1C-D926-4D1B-A76C-EB2C164494DA%7D", "label": "eregulations.ct.gov", "score": 10.5427789688, "published": false}, {"hash": "jiprYin1YAl", "uri": "https://www.ctdssmap.com/CTPortal/Information/Get%20Download%20File/tabid/44/Default.aspx?Filename=ch7_phys.pdf&URI=Manuals/ch7_phys.pdf", "label": "www.ctdssmap.com", "score": 9.3655033112, "published": false}], "snippet": "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;", "size": 74, "snippet_links": [{"key": "provision-of-a", "type": "clause", "offset": [23, 37]}, {"key": "delivery-of-goods", "type": "definition", "offset": [53, 70]}, {"key": "the-department", "type": "clause", "offset": [76, 90]}, {"key": "the-provider", "type": "clause", "offset": [98, 110]}, {"key": "the-service", "type": "clause", "offset": [129, 140]}, {"key": "the-goods", "type": "clause", "offset": [153, 162]}], "hash": "ad75b7de5e28213b42e7fa7e3095857a", "id": 2}, {"samples": [{"hash": "iPNHHSej2ys", "uri": "/contracts/iPNHHSej2ys#prior-authorization", "label": "Medical and Hospital Service Contract", "score": 26.697467804, "published": true}, {"hash": "bz8sHQ3jFQt", "uri": "/contracts/bz8sHQ3jFQt#prior-authorization", "label": "Medical and Hospital Service Contract With Point of Service Rider", "score": 26.697467804, "published": true}, {"hash": "2b27iuervqT", "uri": "/contracts/2b27iuervqT#prior-authorization", "label": "Medical and Hospital Service Contract", "score": 26.697467804, "published": true}], "snippet": "means a decision by \u2587\u2587\u2587\u2587\u2587, prior to the time a Health Care Service or other benefit is to be delivered, that the Health Care Services are Medically Necessary. 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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.", "size": 51, "snippet_links": [{"key": "department-of-community-health", "type": "definition", "offset": [35, 65]}, {"key": "delivery-of", "type": "clause", "offset": [105, 116]}, {"key": "pharmaceutical-services", "type": "clause", "offset": [128, 151]}, {"key": "application-of", "type": "clause", "offset": [183, 197]}, {"key": "department-or", "type": "definition", "offset": [228, 241]}, {"key": "covered-by", "type": "definition", "offset": [299, 309]}, {"key": "pursuant-to-a", "type": "definition", "offset": [355, 368]}, {"key": "contract-for", "type": "definition", "offset": [369, 381]}, {"key": "the-process", "type": "clause", "offset": [398, 409]}, {"key": "to-verify", "type": "definition", "offset": [435, 444]}, {"key": "the-proposed", "type": "clause", "offset": [496, 508]}, {"key": "medical-use", "type": "definition", "offset": [509, 520]}, {"key": "a-prescription-drug", "type": "clause", "offset": [524, 543]}, {"key": "this-act", "type": "definition", "offset": [664, 672]}, {"key": "not-included", "type": "clause", "offset": [828, 840]}, {"key": "preferred-drug-list", "type": "clause", "offset": [846, 865]}, {"key": "subject-to", "type": "clause", "offset": [877, 887]}, {"key": "special-access", "type": "clause", "offset": [888, 902]}, {"key": "reimbursement-restrictions", "type": "clause", "offset": [906, 932]}], "hash": "4f1cfbfab259d9636e1f4d0133eaa405", "id": 4}, {"samples": [{"hash": "1xcSeNVYrg2", "uri": "https://nevadahealthcoop.org/wp-content/uploads/Northern-Simple-Facil-Health-EOC-Off-Ex-Ind.pdf", "label": "nevadahealthcoop.org", "score": 9.6613740921, "published": false}, {"hash": "42Ba5LK7icR", "uri": "https://nevadahealthcoop.org/wp-content/uploads/2014/11/Union-Star_Estrella-EOC-On-Ex-Ind.pdf", "label": "nevadahealthcoop.org", "score": 9.6492319107, "published": false}, {"hash": "3qSgfBVwydi", "uri": "https://nevadahealthcoop.org/wp-content/uploads/2014/11/Co-Options-Simple-On-Ex-Ind.pdf", "label": "nevadahealthcoop.org", "score": 7.5763177872, "published": false}], "snippet": "or \u201cPrior Authorized\u201d 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. 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Prior Authorization is not an agreement to pay for a service.", "size": 29, "snippet_links": [{"key": "prior-authorized", "type": "definition", "offset": [4, 20]}, {"key": "emergency-healthcare-services", "type": "clause", "offset": [108, 137]}, {"key": "to-be-considered", "type": "clause", "offset": [171, 187]}, {"key": "covered-services", "type": "clause", "offset": [188, 204]}, {"key": "pay-for", "type": "definition", "offset": [249, 256]}], "hash": "6c6522e1c5fb6e27d2c22affdb92823b", "id": 7}, {"samples": [{"hash": "9D8itWmT1K", "uri": "/contracts/9D8itWmT1K#prior-authorization", "label": "Home Health Care Agency Contract", "score": 29.7222690582, "published": true}, {"hash": "78TRT84YfLd", "uri": "/contracts/78TRT84YfLd#prior-authorization", "label": "Network Provider Home Health Care Agency Contract", "score": 27.2777996063, "published": true}, {"hash": "7XbJltHhWM7", "uri": "/contracts/7XbJltHhWM7#prior-authorization", "label": "Home Health Care Agency Contract", "score": 24.3620815277, "published": true}], "snippet": "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.", "size": 28, "snippet_links": [{"key": "performed-by", "type": "clause", "offset": [17, 29]}, {"key": "medical-necessity", "type": "definition", "offset": [67, 84]}, {"key": "this-contract", "type": "definition", "offset": [138, 151]}, {"key": "to-services", "type": "clause", "offset": [159, 170]}], "hash": "292a67a89f130217e52deffe833eeffc", "id": 8}, {"samples": [{"hash": "jmPaLiWc39Q", "uri": "https://www.legis.iowa.gov/docs/iac/chapter/02-19-2025.441.73.rtf", "label": "www.legis.iowa.gov", "score": 19.5482584729, "published": false}, {"hash": "hZhx3JSkntG", "uri": "https://www.legis.iowa.gov/docs/aco/arc/6959C.pdf", "label": "www.legis.iowa.gov", "score": 17.8913593292, "published": false}, {"hash": "2XNCRpoKFeP", "uri": "https://www.legis.iowa.gov/docs/iac/chapter/02-07-2024.441.73.pdf", "label": "www.legis.iowa.gov", "score": 17.2118301392, "published": false}], "snippet": "means the process of obtaining prior approval as to the appropriateness of a service or medication. 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