Get Submitting Requests For Prior Authorization - Molina Healthcare Inc.

16 Tips That Speed Up The Prior Authorization Process Sign up for payor newsletters. Stay informed of changing industry standards. Designate prior authorization responsibilities to the same staff member(s). Inform scheduling staff about procedures that require prior authorizations.

The general process has many names including precertification, pre-authorization, prior approval, and predetermination.

Receive request for prior authorizations through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored. Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.

Prior authorization (also called “preauthorization” and “precertification”) refers to a requirement by health plans for patients to obtain approval of a health care service or medication before the care is provided. This allows the plan to evaluate whether care is medically necessary and otherwise covered.

Under prior authorization, the provider or supplier submits the prior authorization request and receives the decision before services are rendered.

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.

Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control 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.

Pharmacy providers and prescribers can submit a PA request via fax by utilizing the following approved forms: 50-1, 50-2, 61-211, or the Medi-Cal Rx PA Request Form, available January 1, 2022, in Reference Materials at .medi-calrx.dhcs.ca.gov/provider/forms/.