A PA request is an extra step that is sometimes required before a member receives a specific service or procedure. A PA will not allow a service that is non-covered or a specific exclusion under the Member Certificate. For example, if cosmetic surgery is an exclusion of the policy, a PA will not change that benefit.
PA is a technique for minimizing costs, wherein benefits are only paid if the medical care has been pre-approved by the insurance company. Some specific services require PA so that Medical Affairs can review the medical necessity of these services. Seeking services with non-plan providers/out-of-network will usually require PA.
A member must obtain a written authorization letter from the concerned Payer, approving the requested service or procedure, to give to the Provider. It is the member’s responsibility to secure written authorization approval before receiving treatment to ensure proper handling of the claim.
PriorAuthOnline allows healthcare professionals to have all their prior authorizations taken care of by trained experts, by sending their requirements, having them processed and getting back the requisite approval, all via online means. PriorAuthOnline works on PA requests for all Medicare Part D plans, Medicaid plans, and virtually all Commercial plans.
PriorAuthOnline is designed to take the pain out of prior authorization. You can save an enormous amount of time and money by partnering with us. Eliminate errors, minimize effort and free yourself from tedious paperwork, and get more auths completed in less time.
We work hard to take every step necessary to protect health-related data. All information transferred to and from PriorAuthOnline is encrypted through SSL (Secure Sockets Layer) technology, up to and above the industry standard. Our servers are managed securely and backed up properly, among other safeguards. Our Terms of Service comply with insurance plan rules, as well as Medicare, Medicaid, and HIPAA guidelines.
PriorAuthOnline provides prior authorization assistance for patients with prescription drug coverage. If you have a patient who does not have insurance for medications, you may want to contact The Partnership for Prescription Drug Assistance via the web at PPARX.org or by phone at 1-888-4PPA-NOW (1-888-477-2669) or another payment assistance program.
PriorAuthOnline is fully compliant with the following browsers:
No. PriorAuthOnline is web based, and does not require any additional software on your computer.
The plan will alert the provider's office by fax when a PA request is approved. The plan will typically notify them using the fax number on the submitted PA. For electronic PA requests, you may also receive a determination directly through PriorAuthOnline. On average, it takes between 1 and 5 business days for the plan to come to a determination.
It is typically up to the provider to let the pharmacy know when they can fill the prescription. Pharmacies can request to be notified of PA determinations by updating their preferences in PriorAuthOnline. While this is not a guarantee that the plan will notify the pharmacy, it does add the pharmacy's contact information and notification request to the PA.
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