Request for Additional Information. The Prior Authorization process may require additional documentation from the Member’s health care provider or pharmacist. In addition to the written request for Prior Authorization, the health care provider or pharmacist may be required to include pertinent documentation explaining the proposed services, the functional aspects of the treatment, the projected outcome, treatment plan and any other supporting documentation, study models, prescription, itemized repair and replacement cost statements, photographs, x-rays, etc., as may be requested by The Plan to make a determination of coverage pursuant to the terms and conditions of this Contract.
Appears in 6 contracts
Samples: Health Insurance Contract, Health Insurance Contract, Health Insurance Plan
