Services that Require Prior Authorization Clause Samples

Services that Require Prior Authorization a. If your Health Care Provider is a Participating Provider, he or she will handle all authorizations, notifications and utilization reviews with AvMed. If your Health Care Provider is a Non-Participating Provider, you are responsible for making sure he or she contacts AvMed to obtain Prior Authorization for a Covered Service when it is required. Please refer to your AvMed Identification Card for the telephone number where authorization may be obtained, or have your Health Professional call 1-800- ▇▇▇-▇▇▇▇.
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Services that Require Prior Authorization a. Members should remember that services provided or received without Prior Authorization from AvMed when authorization is required, are not covered except when required to treat an Emergency Medical Condition. Furthermore, if an inpatient admission is extended beyond the number of days initially approved, without Prior Authorization for the continued stay, it may result in services not being covered. Before a service is performed, you should verify with your Health Professional that the service has received Prior Authorization. If you are unable to secure verification from your Health Professional, you may also call AvMed at ▇-▇▇▇-▇▇▇-▇▇▇▇. b. Services that require Prior Authorization from AvMed include: i. inpatient admissions (including Hospital and observation stays, Skilled Nursing Facilities, Ventilator Dependent Care, acute rehabilitation and inpatient mental health or substance abuse services); ii. surgical procedures or services performed in an outpatient Hospital or Ambulatory Surgery Center; iii. complex diagnostic and therapeutic, and sub-specialty procedures (including CT, CTA, MRI, MRA, PET, and nuclear medicine); iv. radiation oncology; v. certain medications including Injectable Medications, and select medications administered in a Physician’s office, an outpatient Hospital or infusion therapy setting; vi. all Home Health Care Services; vii. cardiac rehabilitation; viii. dialysis services; ix. transplant services; x. non-emergency transport services; xi. care rendered by Non-Participating Providers (except for Emergency Medical Services and Care). c. Services requiring Prior Authorization may change from time to time. For more information about which services require Prior Authorization, contact ▇▇▇▇▇’s Member Engagement Center at 1-800- 882-8633. You should always make sure your Physician contacts us to obtain Prior Authorization.
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Services that Require Prior Authorization. In or Out-of-network (outside of the 5-county area)
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Services that Require Prior Authorization a. If your Health Care Provider is an In-Network Provider, he or she will handle all authorizations, notifications and utilization reviews with AvMed. If your Health Care Provider is a Non-Participating Provider, you are responsible for making sure he or she contacts AvMed to obtain Prior Authorization for a Covered Service when it is required. Please refer to your AvMed Identification Card for the telephone number where authorization may be obtained, or have your Health Professional call 1-800- ▇▇▇-▇▇▇▇. b. Members should remember that services provided or received without Prior Authorization from AvMed when authorization is required, are not covered except when required to treat an Emergency Medical Condition. Furthermore, if an inpatient admission is extended beyond the number of days initially approved, without Prior Authorization for the continued stay, it may result in services not being covered. Before a service is performed, you should verify with your Health Professional that the service has received Prior Authorization. If you are unable to secure verification from your Health Professional, you may also call AvMed at ▇-▇▇▇-▇▇▇-▇▇▇▇. c. Services that require Prior Authorization from AvMed include: i. inpatient admissions (including Hospital and observation stays, Skilled Nursing Facilities, Ventilator Dependent Care, acute rehabilitation and inpatient mental health or substance abuse services); ii. surgical procedures or services performed in an outpatient Hospital or Ambulatory Surgery Center; iii. complex diagnostic and therapeutic, and sub-specialty procedures (including CT, CTA, MRI, MRA, PET, and nuclear medicine);
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Services that Require Prior Authorization a. Members should remember that services provided or received without Prior Authorization from AvMed when authorization is required, are not covered except when required to treat an Emergency Medical Condition. Furthermore, if an inpatient admission is extended beyond the number of days initially approved, without Prior Authorization for the continued stay, it may result in services not being covered. Before a service is performed, you should verify with your Health Professional that the service has received Prior Authorization. If you are unable to secure verification from your Health Professional, you may also call AvMed at ▇-▇▇▇-▇▇▇-▇▇▇▇.
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Related to Services that Require Prior Authorization

  • Prior Authorization A determination to authorize a Provider’s request, pursuant to services covered in the MississippiCAN Program, to provide a service or course of treatment of a specific duration and scope to a Member prior to the initiation or continuation of the service.

  • Authorization of Agreement This Agreement has been duly authorized, executed and delivered by the Company.

  • Authorization of Agreement, Etc The Borrower has the right and power, and has taken all necessary action to authorize it, to borrow and obtain other extensions of credit hereunder. The Borrower and each other Loan Party has the right and power, and has taken all necessary action to authorize it, to execute, deliver and perform each of the Loan Documents to which it is a party in accordance with their respective terms and to consummate the transactions contemplated hereby and thereby. The Loan Documents to which the Borrower or any other Loan Party is a party have been duly executed and delivered by the duly authorized officers of such Person and each is a legal, valid and binding obligation of such Person enforceable against such Person in accordance with its respective terms except as the same may be limited by bankruptcy, insolvency, and other similar laws affecting the rights of creditors generally and the availability of equitable remedies for the enforcement of certain obligations (other than the payment of principal) contained herein or therein may be limited by equitable principles generally.

  • Information Release Authorization Throughout the Term, you authorize Homefield Energy to obtain information from the DSP that includes, but is not limited to, your account name, account number, billing address, service address, telephone number, standard offer service type, meter readings, and, when charges hereunder are included on your DSP bill, your billing and payment information. You authorize Homefield Energy to release such information to third parties, including affiliates that need to know such information in connection with your Retail Power service. These authorizations will remain in effect as long as this Agreement is in effect.

  • Authorization of this Agreement This Agreement has been duly authorized, executed and delivered by or on behalf of such Selling Stockholder.