Why is prior authorization important?
Prior authorization allows both the member and healthcare provider to understand coverage decisions before procedures, services, or supplies are received. This process also helps identify members for specialty programs (like case and disease management, for example) that can make the healthcare journey a more seamless experience.
What services require prior authorization?
Prior authorization occurs before any inpatient admission or service, and also for select outpatient procedures and services. Click here for a list of services that require prior authorization.
Below are documents that provide more information about PHP's authorization requirements and service listings.