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When You Need Prior Authorization
There may be times when you need services that require prior authorization from the Health Plan. Your Primary Care Physician is responsible for knowing which services need to be authorized in advance by the plan. Services that must be authorized in advance include:
- Non-emergency hospitalization
- Care at skilled or intermediate nursing facilities
- Certain outpatient laboratory and diagnostic imaging procedures
- Certain medications
- Certain medical equipment like wheelchairs
If you need a service or medication that requires prior authorization, your doctor will send a form called a Treatment Authorization Request (TAR) to the Health Plan (CenCal Health). The TAR will then be reviewed by our Health Services Department staff that will be in touch with your doctor to notify him or her that the request has been approved or denied. If a request is denied, you and your doctor will be notified
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