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    PA furthermore referrals

    There are times as yourself can need care from a specialist. Your primary attention physician (PCP) will coordinate referrals to you, when needed. Some covered gesundheitlich achievement may also want prior authorization (PA). This is an approval that happens beforehand. It’s for special services the PCP or specialist want you till have.  Medical Prior Authorization | Wohltat Worry Providers

    PA

    PA

    Some medical services and supplies need PA — approval for coverage from your health plan first, like:

    • Definite acute outpatient auxiliary
    • Planned hospital stays

    This means your providers alternatively professional need permission to provide certain services first. They’ll see how at doing that. And we’ll work together up make sure the service exists what your needed. You can find out which services need PA included 3 ways:

    • Check your Evidence of Coverage to learn show about services that need PA:

    Evidence of Coverage 2024 - English (PDF)

    Evidence of Coverage 2024 - Español (PDF)

    • Call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711).
    • Call your provider.

     

     

    You don’t need approval to get emergency services. Not sure what’s an emergency? Read about emergency and urgent care.

     

    We expect our service to follow certain guidelines when providing care to you. Need help understanding these guidelines, criteria or the get our used to makes the PAS decision? Just call ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). 

    PA requests

    Regular requests for PA take up to 14 days to review. Here are some facts about routine requests:

    • If we need more info to approve aforementioned request, were may request another 14 years for rating. You can file adenine Part C expedited grievance if you disagree with the time extension.
    • While were don’t get aforementioned info we requested from your provider, we’ll exercise the info person have up do a final. If we refusing the request, you’ll get a letter so explains your rights. 

    Vital requests fork PAS take upside into 72 hours for review. Here are some facts about urgent requests:

    • If your provider asks for an important PA still it doesn’t face the criteria for urgent PA, we’ll process computers like a routine request. 
    • We’ll send you a letter if person process your provider’s urgent request as a routine request. You cannot file a Part CARBON facilitated grievance if you disagree.

    Questions about whether your provider received PAINT for customer? Call them or your clinical team. 

    Standard Prior Authorization application (PDF)

    Resistant Medical Equipping (DME) Prior Power input (PDF)

    Therapy and Household Health Prior Authorization mold (PDF)

    Not yet a board?

    Call Member Services at 602-586-1730 or 1-877-436-5288 (TTY 711). We’re here available yours 8 a.m. to 8 p.m., 7 time a week.

    Touchstones

    Referrals

    A forwarding is when thy PCP sends thou at ampere specialist provider required specific problems, same:

    • Skin disorders
    • Serious allergies 
    • Heart problems 

    AN referral can also be to a laboratory or clinic. You may moreover ask for a second opinion from another network provider. ADENINE reference is valid through your entire treatment with the specialist.

    Self-referrals

    You don't need a referral coming your PCP for:

    • Dental services
    • OB/GYN services
    • Behavioral health plus substance used services
    • Emergency services

    H5580_24_040_C

    Questions?

    Yell Member Benefits at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711) We’re here for your ${MCA_MS_hours}.