Common use of Prior Auth Required Clause in Contracts

Prior Auth Required. Practitioner/Provider agrees to accept our normal reimbursement for similar services and services are provided in New Mexico.  Any care related to the Cancer Clinical Trial that is Investigational requires Authorization. Other medical services that are not Investigational may require Prior Authorization as described in the Prior Authorization Section.  Cer ified Hospice Care Benefits for Inp tient and in-home Hospice services are Covered if you are terminally ill. Services must be provided by an approved Hospice program during a Hospice benefit period and will not be Covered to the extent that they duplicate other Covered Services available to you. Benefits that are provided for by a Hospice or other facility require approval by your Practitioner/Provider and our Prior Authorization. The Hospice benefit period is defined as follows:  Beginning on the date your Practitioner/Provider certifies that you are terminally ill with a life expectancy of six months or less.  Ending six months after it began, u period below, or upon your death. less you require an extension of the Hospice benefit  If you require an extension of the Hospice benefit period, the Hospice must provide a new treatment plan and your Practitioner/Provider must re-authorize your medical condition to us. We will not Authorize more than one additional Hospice benefit period. The following services are Covered:  Inpatient Hospice care  Practitioner/Provider visits by Certified Hospice Practitioner/Providers  Home Health Care Services by approved home health care personnel  Physical therapy  Medical supplies  Prescription Drugs and Medication for the pain and discomfort specifically related to the terminal illness  Medical transportation  Respite care (care that provides a relief for the care-giver) for a period not to exceed five continuous days for every 60 days of Hospice care. No more than two respite care stays will be available during a Hospice benefit period.

Prior Auth Required. Practitioner/Provider agrees to accept our normal reimbursement for similar services and services are provided in New Mexico.  Any care related to the Cancer Clinical Trial that is Investigational requires may require Prior Authorization. Other medical services that are not Investigational may require Prior Authorization as described in the Prior Authorization Section.  Cer ified Hospice Care Benefits for Inp tient Inpatient and in-home Hospice services are Covered if you are terminally ill. Services must be provided by an approved Hospice program during a Hospice benefit period and will not be Covered to the extent that they duplicate other Covered Services available to you. Benefits that are provided for by a Hospice or other facility require approval by your Practitioner/Provider and our Prior Authorization.  The Hospice benefit period is defined as follows:  o Beginning on the date your Practitioner/Provider certifies that you are terminally ill with a life expectancy of six months or less.  o Ending six months after it began, u unless you require an extension of the Hospice benefit period below, or upon your death. less you require an extension of the Hospice benefit  o If you require an extension of the Hospice benefit period, the Hospice must provide a new treatment plan and your Practitioner/Provider must re-authorize your medical condition to us. We will not Authorize more than one additional Hospice benefit period. o You must be a Covered Member throughout your Hospice benefit period.  The following services are Covered:  o Inpatient Hospice care  o Practitioner/Provider visits by Certified Hospice Practitioner/Providers  o Home Health Care Services by approved home health care personnel  o Physical therapy  o Medical supplies  o Prescription Drugs and Medication for the pain and discomfort specifically related to the terminal illness  o Medical transportation  o Respite care (care that provides a relief for the care-giver) for a period not to exceed five continuous days for every 60 days of Hospice care. No more than two respite care stays will be available during a Hospice benefit period.

Prior Auth Required. Practitioner/Provider agrees to accept our normal reimbursement for similar services and services are provided in New Mexico.  • Any care related to the Cancer Clinical Trial that is Investigational requires Authorization. Other medical services that are not Investigational may require Prior Authorization as described in the Prior Authorization Section.  ⮚ Cer ified Hospice Care Benefits for Inp tient and in-home Hospice services are Covered if you are terminally ill. Services must be provided by an approved Hospice program during a Hospice benefit period and will not be Covered to the extent that they duplicate other Covered Services available to you. Benefits that are provided for by a Hospice or other facility require approval by your Practitioner/Provider and our Prior Authorization. The Hospice benefit period is defined as follows:  • Beginning on the date your Practitioner/Provider certifies that you are terminally ill with a life expectancy of six months or less.  • Ending six months after it began, u period below, or upon your death. less you require an extension of the Hospice benefit  • If you require an extension of the Hospice benefit period, the Hospice must provide a new treatment plan and your Practitioner/Provider must re-authorize your medical condition to us. We will not Authorize more than one additional Hospice benefit period. • You must be a Covered Member throughout your Hospice benefit period. The following services are Covered:  • Inpatient Hospice care  • Practitioner/Provider visits by Certified Hospice Practitioner/Providers  • Home Health Care Services by approved home health care personnel  • Physical therapy  • Medical supplies  • Prescription Drugs and Medication for the pain and discomfort specifically related to the terminal illness  • Medical transportation  • Respite care (care that provides a relief for the care-giver) for a period not to exceed five continuous days for every 60 days of Hospice care. No more than two respite care stays will be available during a Hospice benefit period.

Prior Auth Required. Practitioner/Provider agrees to accept our normal reimbursement for similar services and services are provided in New Mexico.  Any care related to the Cancer Clinical Trial that is Investigational requires Authorization. Other medical services that are not Investigational may require Prior Authorization as described in the Prior Authorization Section.  Cer ified Hospice Care Benefits for Inp tient Inpatient and in-home Hospice services are Covered if you are terminally ill. Services must be provided by an approved Hospice program during a Hospice benefit period and will not be Covered to the extent that they duplicate other Covered Services available to you. Benefits that are provided for by a Hospice or other facility require approval by your Practitioner/Provider and our Prior Authorization.  The Hospice benefit period is defined as follows:  o Beginning on the date your Practitioner/Provider certifies that you are terminally ill with a life expectancy of six months or less.  o Ending six months after it began, u period below, or upon your death. less unless you require an extension of the Hospice benefit  period bel w, or upon your death. o If you require an extension of the Hospice benefit period, the Hospice must provide a new treatment plan and your Practitioner/Provider must re-authorize your medical condition to us. period. We will not Authorize more than one additional Hospice benefit o You must be a Covered Member throughout your Hospice benefit period.  The following services are Covered:  o Inpatient Hospice care  o Practitioner/Provider visits by Certified Hospice Practitioner/Providers  o Home Health Care Services by approved home health care personnel  o Physical therapy  o Medical supplies  o Prescription Drugs and Medication for the pain and discomfort specifically related to the terminal illness  o Medical transportation  o Respite care (care that provides a relief for the care-giver) for a period not to exceed five continuous days for every 60 days of Hospice care. No more than two respite care stays will be available during a Hospice benefit period.