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1. Schedule of Benefits (Who Pays What) Prior authorization may be required for some services. Please refer to the prior authorization list, which can be found on our website at www.denverhealthmedicalplan.org/priorauthorizationlist.
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How to fill out prior authorization may be

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To fill out prior authorization, follow these steps:
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Step 1: Gather all necessary information such as patient's personal details, insurance information, treating physician information, and medical procedure details.
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Step 2: Contact the patient's insurance company to obtain the prior authorization form and any specific guidelines related to the procedure or medication.
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Step 3: Fill out the prior authorization form accurately and completely. Make sure to include all required supporting documents such as medical records, test results, and clinical notes.
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Step 4: Double-check the filled form for any errors or missing information.
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Step 5: Submit the completed prior authorization form along with the supporting documents to the insurance company either through fax, email, or online portal.
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Step 6: Keep a copy of all the submitted documents for your reference.
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Step 7: Follow up with the insurance company to ensure receipt of the prior authorization request and track its progress.
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Step 8: If the prior authorization is approved, proceed with the planned procedure or medication. If it is denied, review the denial reasons and consider filing an appeal if appropriate.

Who needs prior authorization may be?

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Prior authorization may be needed by:
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- Patients who have health insurance plans that require prior authorization for certain medical procedures, medications, or treatments.
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- Healthcare providers (such as doctors, hospitals, or clinics) who want to ensure reimbursement for specific services before providing them to patients.
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- Pharmacies that need prior authorization to dispense certain medications covered by insurance.
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- Insurance companies who want to control costs and ensure appropriate utilization of healthcare services.
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Prior authorization is a process used by insurance companies to determine if they will cover a prescribed medication or medical procedure.
Healthcare providers are typically required to file for prior authorization.
Prior authorization forms can usually be filled out online or submitted via fax or mail.
The purpose of prior authorization is to control costs and ensure appropriate use of medical services.
Prior authorization forms typically require information such as patient demographics, diagnosis codes, and treatment plans.
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