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Making Sense of Preauthorization

January 23, 2020

To: All Providers

We know obtaining preauthorizations can sometimes feel daunting. This process is important because it helps us pay claims faster, and reduces the likelihood of unexpected costs or denied charges for your patients.

We continually evaluate the appropriateness and effectiveness of our preauthorization policies. In fact, over the last several years, we’ve lifted preauthorization requirements from more than 500 codes.

Here are a few tips that may help:

  • You can check whether a service requires preauthorization by logging into our provider portal and consulting our Code and Comment tool. Your HEALTHeNET log in credentials can be used to access our portal.
    • You can search by procedure code or enter the procedure description
    • You will be given the preauthorization requirement or be linked to our Medical Protocols (secure) for additional clinical criteria.
  • Preauthorization forms for most services and procedures can be found at > Forms.
  • Preauthorization requests for some services are reviewed by our partners. Information on how to reach those partners to request preauthorization can be found on our website at > Policies & Guidelines > Prior Authorization
  • Once your request is submitted, you can visit HEALTHeNET to check the status of a preauthorization. You will be notified by phone once your request has been reviewed and a decision has been made.
  • You can access medical preauthorization letters on our secure provider portal the day after you receive approval or denial over the phone.
  • Urgent care or emergency admissions do not require preauthorization.

For more about preauthorization, click below:

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