Common use of Services Requiring Prior Authorization Clause in Contracts

Services Requiring Prior Authorization. All Covered Services not provided by the Member's PCP require written Prior Authorization from the PCP and HPN’s Managed Care Program. The following Covered Services require Prior Authorization and review through HPN’s Managed Care Program.  Non-emergency Inpatient admissions and extensions of stay beyond the original certified length of stay in a Hospital, Skilled Nursing Facility or Hospice.  All outpatient surgery provided in any setting, including technical and professional services.  Diagnostic and Therapeutic Services.  Home Healthcare Services.  Severe Mental Illness, Mental Health and Substance Abuse Services.  All Specialist visits or consultations.  Prosthetic Devices and Orthotic Devices.  Courses of treatment, including but not limited to allergy testing or treatment (e.g., skin, RAST); angioplasty; anti-cancer drug therapy; dialysis; physiotherapy or Manual Manipulation; or rehabilitation therapy (physical, speech, occupational).

Services Requiring Prior Authorization. All Covered Services not provided by the Member's PCP require written Prior Authorization from the PCP and HPN’s Managed Care Program. The following Covered Services require Prior Authorization and review through HPN’s Managed Care Program.  Non-emergency Inpatient admissions and extensions of stay beyond the original certified length of stay in a Hospital, Skilled Nursing Facility or Hospice.  All outpatient surgery provided in any setting, including technical and professional services.  Diagnostic and Therapeutic Services.  Home Healthcare Services.  Severe Mental Illness, Mental Health and Substance Abuse Services.  All Specialist visits or consultations.  Prosthetic Devices and Orthotic Devices.  Courses of treatment, including but not limited to allergy testing or treatment (e.g., skin, RAST); angioplasty; anti-cancer drug therapy; dialysis; physiotherapy or Manual Manipulation; or habilitative services and rehabilitation therapy (physical, speech, occupational).

Services Requiring Prior Authorization. All Covered Services not provided by the Member's PCP require written Prior Authorization from the PCP and HPN’s Managed Care Program. The following Covered Services require Prior Authorization and review through HPN’s Managed Care Program.  • Non-emergency Inpatient admissions and extensions of stay beyond the original certified length of stay in a Hospital, Skilled Nursing Facility or Hospice.  • All outpatient surgery provided in any setting, including technical and professional services.  • Diagnostic and Therapeutic Services.  • Home Healthcare Services.  • Severe Mental Illness, Mental Health and Substance Abuse Services.  • All Specialist visits or consultations.  • Prosthetic Devices and Orthotic Devices.  • Courses of treatment, including but not limited to allergy testing or treatment (e.g., skin, RAST); angioplasty; anti-cancer drug therapy; dialysis; physiotherapy or Manual Manipulation; or habilitative services and rehabilitation therapy (physical, speech, occupational).

Services Requiring Prior Authorization. All Covered Services not provided by the Member's PCP require written Prior Authorization from the PCP and HPN’s Managed Care Program. The following Covered Services require Prior Authorization and review through HPN’s Managed Care Program.  : • Non-emergency Inpatient admissions and extensions of stay beyond the original certified length of stay in a Hospital, Skilled Nursing Facility or Hospice.  • All outpatient surgery provided in any setting, including technical and professional services.  • Diagnostic and Therapeutic Services.  • Home Healthcare Services.  • Severe Mental Illness, Mental Health and Substance Abuse Services.  • All Specialist visits or consultations.  • Prosthetic Devices and Orthotic Devices.  • Courses of treatment, including but not limited to allergy testing or treatment (e.g., skin, RAST); angioplasty; anti-cancer drug therapy; dialysis; physiotherapy or Manual Manipulation; or habilitative services and rehabilitation therapy (physical, speech, occupational).