Common use of Preauthorization Clause in Contracts

Preauthorization. Services for which preauthorization is recommended are marked with an asterisk (*) in the Summary of Medical Benefits. Preauthorization is defined in Section 8.0. BCBSRI network providers are responsible for obtaining preauthorization for all applicable covered health care services. BlueCard providers are responsible for obtaining preauthorization for all applicable inpatient facility covered health care services. In some circumstances, you are responsible for obtaining preauthorization. In order for you to obtain preauthorization for a covered health care service, please do the following:  For all covered health care services (except mental health and substance abuse), provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider call our Customer Service Department.  For mental health and substance abuse services provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider call 0-000-000-0000 prior to receiving care. Lines are open 24 hours a day, 7 days per week. If you are responsible for obtaining preauthorization, we will send to you notification of the preauthorization determination within fourteen (14) calendar days from receipt of the request or prior to the date of service. Please see Section 8.0 for the definition of preauthorization. You may request an expedited preauthorization review if the circumstances are an emergency. If an expedited preauthorization review is received by us, we will respond to you with a determination within seventy-two (72) hours or in less than seventy two (72) hours (taking into consideration medical exigencies)following receipt of the request. Services for which prescription drug preauthorization is required are marked with the symbol (+) in the Summary of Pharmacy Benefits. To obtain the required prescription drug preauthorization for certain covered prescription drugs please request your prescribing physician to call our pharmacy benefits administrator, using the number listed for the “Pharmacist” on the back of your ID card. You can call our Customer Service Department at (000) 000-0000 or 0-000-000-0000 or visit our Web site at XXXXXX.xxx to see if a prescription drug requires prescription drug preauthorization. Prescription drug preauthorization is defined in Section 3.27.

Preauthorization. Services for which preauthorization is recommended are marked with an asterisk (*) in the Summary of Medical Benefits. Preauthorization is defined in Section 8.0. BCBSRI network providers are responsible for obtaining preauthorization for all applicable covered health care services. BlueCard providers are responsible for obtaining preauthorization for all applicable inpatient facility covered health care services. In some circumstances, you are responsible for obtaining preauthorization. In order for you to obtain preauthorization for a covered health care service, please do the following:  • For all covered health care services (except mental health and substance abuse), provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider call our Customer Service Department.  • For mental health and substance abuse use disorder services provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider call 0-000-000-0000 prior to receiving care. Lines are open 24 hours a day, 7 days per week. If you are responsible for obtaining preauthorization, we will send to you notification of the preauthorization determination within fourteen (14) calendar days from receipt of the request or prior to the date of service. Please see Section 8.0 for the definition of preauthorization. Expedited Preauthorization Review You may request an expedited preauthorization review if the circumstances are an emergency. If an expedited preauthorization review is received by us, we will respond to you with a determination within seventy-two (72) hours or in less than seventy seventy-two (72) hours (taking into consideration medical exigencies)following exigencies) following receipt of the request. Services for which prescription drug preauthorization is required are marked with the symbol (+) in the Summary of Pharmacy Benefits. To obtain the required prescription drug preauthorization for certain covered prescription drugs please request your prescribing physician to call our pharmacy benefits administrator, using the number listed for the “Pharmacist” on the back of your ID card. You can call our Customer Service Department at (000) 000-0000 or 0-000-000-0000 or visit our Web site at XXXXXX.xxx to see if a prescription drug requires prescription drug preauthorization. Prescription drug preauthorization is defined in Section 3.27.

Preauthorization. Services for which preauthorization is recommended are marked with an asterisk (*) in the Summary of Medical Benefits. Preauthorization is defined in Section 8.0. BCBSRI network providers are responsible for obtaining preauthorization for all applicable covered health care services. BlueCard providers are responsible for obtaining preauthorization for all applicable inpatient facility covered health care services. In some circumstances, you are responsible for obtaining preauthorization. In order for you to obtain preauthorization for a covered health care service, please do the following:  • For all covered health care services (except mental health and substance abuse), provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider call our Customer Service Department.  • For mental health and substance abuse services provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider call 0-000-000-0000 prior to receiving care. Lines are open 24 hours a day, 7 days per week. If you are responsible for obtaining preauthorization, we will send to you notification of the preauthorization determination within fourteen (14) calendar days from receipt of the request or prior to the date of service. Please see Section 8.0 for the definition of preauthorization. You may request an expedited preauthorization review if the circumstances are an emergency. If an expedited preauthorization review is received by us, we will respond to you with a determination within seventy-two (72) hours or in less than seventy two (72) hours (taking into consideration medical exigencies)following receipt of the request. Services for which prescription drug preauthorization is required are marked with the symbol (+) in the Summary of Pharmacy Benefits. To obtain the required prescription drug preauthorization for certain covered prescription drugs please request your prescribing physician to call our pharmacy benefits administrator, using the number listed for the “Pharmacist” on the back of your ID card. You can call our Customer Service Department at (000) 000-0000 or 0-000-000-0000 or visit our Web site at XXXXXX.xxx to see if a prescription drug requires prescription drug preauthorization. Prescription drug preauthorization is defined in Section 3.27.

Preauthorization. Services for which preauthorization is recommended are marked with an asterisk (*) in the Summary of Medical Benefits. Preauthorization is defined in Section 8.0. BCBSRI network Network providers in Rhode Island are responsible for obtaining preauthorization for all applicable covered health care services. BlueCard providers are responsible for obtaining preauthorization for all applicable inpatient facility covered health care services. In some circumstances, you are responsible for obtaining to obtain preauthorization. In order for you to obtain preauthorization for a covered health care service, please do the following:  • For all covered health care services (except mental health and substance abuse), ) provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider PPO providers call our Customer Service Department.  • For mental health and substance abuse services provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider PPO providers call 0-000-000-0000 prior to receiving care. Lines are open 24 hours a day, 7 days per week. If you are responsible for obtaining preauthorization, we will send to you notification of the preauthorization determination within fourteen (14) calendar days from receipt of the request or prior to the date of service. Please see Section 8.0 for the definition of preauthorization. You may request an expedited preauthorization review if the circumstances are an emergency. If an expedited preauthorization review is received by us, we will respond to you with a determination within seventy-seventy two (72) hours or in less than seventy two (72) hours (taking into consideration medical exigencies)following receipt of the request. Services for which prescription drug preauthorization is required are marked with the symbol (+) in the Summary of Pharmacy Benefits. To obtain the required prescription drug preauthorization for certain covered prescription drugs please request your prescribing physician to call our pharmacy benefits administrator, using the number listed for the “Pharmacist” on the back of your ID card. You can call our Customer Service Department at (000) 000-0000 or 0-000-000-0000 or visit our Web site at XXXXXX.xxx to see if a prescription drug requires prescription drug preauthorization. Prescription drug preauthorization is defined in Section 3.27.

Preauthorization. Services for which preauthorization is recommended are marked with an asterisk (*) in the Summary of Medical Benefits. Preauthorization is defined in Section 8.0. BCBSRI network providers are responsible for obtaining preauthorization for all applicable covered health care services. BlueCard providers are responsible for obtaining preauthorization for all applicable inpatient facility covered health care services. In some circumstances, you are responsible for obtaining preauthorization. In order for you to obtain preauthorization for a covered health care service, please do the following:  • For all covered health care services (except mental health and substance abuseuse disorder), provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider call our Customer Service Department.  • For mental health and substance abuse use disorder services provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider call 0-000-000-0000 prior to receiving care. Lines are open 24 hours a day, 7 days per week. If you are responsible for obtaining preauthorization, we will send to you notification of the preauthorization determination within fourteen (14) calendar days from receipt of the request or prior to the date of service. Please see Section 8.0 for the definition of preauthorization. Expedited Preauthorization Review You may request an expedited preauthorization review if the circumstances are an emergency. If an expedited preauthorization review is received by us, we will respond to you with a determination within seventy-two (72) hours or in less than seventy seventy-two (72) hours (taking into consideration medical exigencies)following exigencies) following receipt of the request. Services for which prescription drug preauthorization is required are marked with the symbol (+) in the Summary of Pharmacy Benefits. To obtain the required prescription drug preauthorization for certain covered prescription drugs please request your prescribing physician to call our pharmacy benefits administrator, using the number listed for the “Pharmacist” on the back of your ID card. You can call our Customer Service Department at (000) 000-0000 or 0-000-000-0000 or visit our Web site at XXXXXX.xxx to see if a prescription drug requires prescription drug preauthorization. Prescription drug preauthorization is defined in Section 3.27.

Preauthorization. Services for which preauthorization is recommended are marked with an asterisk (*) in the Summary of Medical Benefits. Preauthorization is defined in Section 8.0. BCBSRI network Network providers in Rhode Island are responsible for obtaining preauthorization for all applicable covered health care services. BlueCard providers are responsible for obtaining preauthorization for all applicable inpatient facility covered health care services. In some circumstances, you are responsible for obtaining to obtain preauthorization. In order for you to obtain preauthorization for a covered health care service, please do the following:  • For all covered health care services (except mental health and substance abuse), chemical dependency) provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider PPO providers call our Customer Service Department.  • For mental health and substance abuse chemical dependency services provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider PPO providers call 0-000-000-0000 prior to receiving care. Lines are open 24 hours a day, 7 days per week. If you are responsible for obtaining preauthorization, we will send to you notification of the preauthorization determination within fourteen (14) calendar days from receipt of the request or prior to the date of service. Please see Section 8.0 for the definition of preauthorization. You may request an expedited preauthorization review if the circumstances are an emergency. If an expedited preauthorization review is received by us, we will respond to you with a determination within seventy-two (72) hours or in less than seventy two (72) hours (taking into consideration medical exigencies)following following receipt of the request. Services for which prescription drug preauthorization is required are marked with the symbol (+) in the Summary of Pharmacy Benefits. To obtain the required prescription drug preauthorization for certain covered prescription drugs please request your prescribing physician to call our pharmacy benefits administrator, using the number listed for the “Pharmacist” on the back of your ID card. You can call our Customer Service Department at (000) 000-0000 or 0-000-000-0000 or visit our Web site at XXXXXX.xxx to see if a prescription drug requires prescription drug preauthorization. Prescription drug preauthorization is defined in Section 3.27.

Preauthorization. Services for which preauthorization is recommended are marked with an asterisk (*) in the Summary of Medical Benefits. Preauthorization is defined in Section 8.0. BCBSRI network providers are responsible for obtaining preauthorization for all applicable covered health care services. BlueCard providers are responsible for obtaining preauthorization for all applicable inpatient facility covered health care services. In some circumstances, you are responsible for obtaining preauthorization. In order for you to obtain preauthorization for a covered health care service, please do the following:  For all covered health care services (except mental health and substance abuseuse disorder), provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider call our Customer Service Department.  For mental health and substance abuse use disorder services provided by non-network providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider call 0-000-000-0000 prior to receiving care. Lines are open 24 hours a day, 7 days per week. If you are responsible for obtaining preauthorization, we will send to you notification of the preauthorization determination within fourteen (14) calendar days from receipt of the request or prior to the date of service. Please see Section 8.0 for the definition of preauthorization. Expedited Preauthorization Review You may request an expedited preauthorization review if the circumstances are an emergency. If an expedited preauthorization review is received by us, we will respond to you with a determination within seventy-two (72) hours or in less than seventy seventy-two (72) hours (taking into consideration medical exigencies)following exigencies) following receipt of the request. Services for which prescription drug preauthorization is required are marked with the symbol (+) in the Summary of Pharmacy Benefits. To obtain the required prescription drug preauthorization for certain covered prescription drugs please request your prescribing physician to call our pharmacy benefits administrator, using the number listed for the “Pharmacist” on the back of your ID card. You can call our Customer Service Department at (000) 000-0000 or 0-000-000-0000 or visit our Web site at XXXXXX.xxx to see if a prescription drug requires prescription drug preauthorization. Prescription drug preauthorization is defined in Section 3.27.

Preauthorization. Services for which preauthorization is recommended are marked with an asterisk (*) in the Summary of Medical Benefits. Preauthorization is defined in Section 8.0. BCBSRI network Network providers in Rhode Island are responsible for obtaining preauthorization for all applicable covered health care services. BlueCard providers are responsible for obtaining preauthorization for all applicable inpatient facility covered health care services. In some circumstances, you are responsible for obtaining to obtain preauthorization. In order for you to obtain preauthorization for a covered health care service, please do the following:  • For all covered health care services (except mental health and substance abuse), ) provided by non-network providers or for non-inpatient facility by another Blue Cross plan’s designated BlueCard PPO providers call our Customer Service Department. • For mental health and substance abuse services provided by another Blue Cross plan’s designated BlueCard provider call our Customer Service Department.  For mental health and substance abuse services provided by non-network PPO providers or for non-inpatient facility services provided by another Blue Cross plan’s designated BlueCard provider call 0-000-000-0000 prior to receiving care. Lines are open 24 hours a day, 7 days per week. If you are responsible for obtaining preauthorization, we will send to you notification of the preauthorization determination within fourteen (14) calendar days from receipt of the request or prior to the date of service. Please see Section 8.0 for the definition of preauthorization. You may request an expedited preauthorization review if the circumstances are an emergency. If an expedited preauthorization review is received by us, we will respond to you with a determination within seventy-seventy two (72) hours or in less than seventy two (72) hours (taking into consideration medical exigencies)following receipt of the request. Services for which prescription drug preauthorization is required are marked with the symbol (+) in the Summary of Pharmacy Benefits. To obtain the required prescription drug preauthorization for certain covered prescription drugs please request your prescribing physician to call our pharmacy benefits administrator, using the number listed for the “Pharmacist” on the back of your ID card. You can call our Customer Service Department at (000) 000-0000 or 0-000-000-0000 or visit our Web site at XXXXXX.xxx to see if a prescription drug requires prescription drug preauthorization. Prescription drug preauthorization is defined in Section 3.27.