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Division of Medicaid and Long Tenn Care State of Nebraska Dave Hangman, Governor and Human Services PROVIDER BULLETIN No 10-12 April 5, 2010, TO: Medicaid Providers of Injectable Pay:h Medications
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What is prior authorization for?
Prior authorization is a process used by insurance companies to determine if they will cover certain medications, procedures, or services before they are provided.
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Healthcare providers such as doctors, hospitals, and pharmacists are usually required to file prior authorization requests.
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To fill out a prior authorization, healthcare providers need to complete a form provided by the insurance company, including relevant patient information, diagnosis, and treatment plan.
What is the purpose of prior authorization for?
The purpose of prior authorization is to ensure that the treatment or service being requested is medically necessary and cost-effective.
What information must be reported on prior authorization for?
Information such as patient demographics, medical history, provider information, diagnosis, treatment plan, and supporting documentation may need to be reported on a prior authorization form.
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