Prior Authorized definition

Prior Authorized means a system that requires a Provider to get approval from HPN before providing non- emergency healthcare services to a Member in order for those services to be considered Covered Services. Prior Authorization is not an agreement to pay for a service.
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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.
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Examples of Prior Authorized in a sentence

  • All benefits for Durable Medical Equipment (“DME”) includes administration, maintenance and operating costs of such equipment, if the equipment is Medically Necessary or Prior Authorized.

  • Prior Authorized Services — In-Plan Services, determined to be Medically Necessary, the utilization of which the PH-MCO manages in accordance with Department-approved Prior Authorization policies and procedures.

  • Inpatient Hospital Services must be Prior Authorized except when requesting emergency services.

  • Benefits payable for expenses incurred in connection with Covered Services, which are not Prior Authorized by the Managed Care Program, will be reduced as shown in the Attachment A Benefit Schedule.

  • Benefits payable for Covered Services which are not Prior Authorized by SHL’s Managed Care Program will be reduced to 50% of what the Insured would have received with Prior Authorization.

  • This includes any Prior Authorized Covered Services obtained from a Non-Plan outpatient facility, such as a laboratory, radiological facility (x-ray), or any complex diagnostic or therapeutic services.

  • All transplant procedures must be Prior Authorized for type of transplant and be Medically Necessary and not Experimental or Investigational according to criteria established by Alliant.

  • If a Covered Transplant Procedure is not performed as scheduled due to a change in the Member’s medical condition or death, benefits will be paid for Prior Authorized Eligible Medical Expenses incurred during the Transplant Benefit Period.

  • The PH-MCO may waive the Prior Authorization requirements for services which are required by the Department to be Prior Authorized.

  • Prior Authorized Services — In-Plan Services, the utilization of which the PH- MCO manages in accordance with Department-approved Prior Authorization policies and procedures.