Common use of AUTHORIZATION REQUIRED Clause in Contracts

AUTHORIZATION REQUIRED. When required in accordance with the terms and conditions of the applicable Health Benefits Plan, and except in case of an Emergency, Specialist Physician shall provide Covered Services only upon receiving prior authorization to treat the Member from the Member's Primary Care Provider or QualCare, all in accordance with the applicable Health Benefits Plan's Referral procedures. Depending on the terms and conditions of the applicable Health Benefits Plan, failure of Specialist Physician to receive said prior authorization may result, at the applicable Payor's option, in nonpayment for those Covered Services provided to the Member. Exceptions to the requirement for prior authorization for specialty services may be made for anesthesiologists, radiologists and pathologists whose services are provided in conjunction with prior authorized services.