Get Health Alliance Prior Authorization

The Prior Authorization Process Flow The healthcare provider must check a health plan's policy or prescription to see if Prior Authorization is needed for the prescribed treatment. The healthcare professional must sign a Prior Authorization request form to verify the medical necessity claim.

A pre-authorization is a restriction placed on certain medications, tests, or health services by your insurance company that requires your doctor to first check and be granted permission before your plan will cover the item.

Some procedures or services that may require prior authorization include: all inpatient services and inpatient rehabilitation. mental health care. substance abuse care. sub-acute skilled care. private duty nursing. home health. hospice. high-tech radiology.

The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider. As mentioned in the “How does prior authorization work?” section above, this will then often prompt a time-consuming back and forth between the provider and payer.

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.

COB exists when an enrollee is also covered by another plan and determines which plan pays first. The COB provision applies when you or your covered Dependent have health care coverage under more than one plan.