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SITEMAP

	For Members > When You Need Prior Authorization(Approval)
	When You Need Prior Authorization (Approval)



	When You Need Prior Authorization (Approval) 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) or if the authorization is for a medication a Medical Request Form (MRF) to the Health Plan. It will be reviewed by our Health Services Department staff who will notify your doctor that the request has been approved, modified (changed) or denied. If the Health Plan denies a Treatment Authorization Request (TAR) or a Medical Request Form (MRF) that your provider submitted, the Health Plan will send a letter to you and your doctor informing you of your right to appeal the denial. In some cases, you have a right to an expedited (faster) (72-hour) appeal if your health or ability to function could be seriously harmed by waiting for a standard appeal, which may take up to 30 days. See the Complaint and Appeal section of your Member Handbook for more information.