Common use of How to Obtain Prior Authorization Clause in Contracts

How to Obtain Prior Authorization. To obtain prior authorization or to confirm that a network provider has obtained prior authorization, contact us by telephone at the telephone number listed on your member identification card before the service or supply is provided to the member. Failure to Obtain Prior Authorization Failure to comply with the prior authorization requirements will result in benefits being reduced. There is a penalty if treatment is not authorized prior to service. The penalty is a 20 percent reduction of the eligible expenses for all charges related to the treatment, not to exceed $1,000. The penalty applies to all otherwise eligible expenses that are: