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Molina Healthcare of Washington
Marketplace Prior Authorization/PreService Review Guide
Effective: 1/1/2016Use Clear Coverage for faster turnaround times.
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What is marketplace prior authorization/pre-service review?
Marketplace prior authorization/pre-service review is a process where healthcare providers must get approval from a health insurance plan before certain services are provided to the patient.
Who is required to file marketplace prior authorization/pre-service review?
Healthcare providers and facilities are required to file marketplace prior authorization/pre-service review.
How to fill out marketplace prior authorization/pre-service review?
Healthcare providers need to submit specific forms and documentation to the insurance plan detailing the requested services and medical necessity.
What is the purpose of marketplace prior authorization/pre-service review?
The purpose is to ensure that the requested medical services are necessary and appropriate, as well as to manage costs and utilization of healthcare services.
What information must be reported on marketplace prior authorization/pre-service review?
Information such as patient demographics, medical history, proposed treatment plan, and provider credentials must be reported on marketplace prior authorization/pre-service review.
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