Prior Authorized definition

Prior Authorized means a system that requires a Provider to get approval from HPN before providing non-emergency healthcare services to a Member in order for those services to be considered Covered Services. Prior Authorization is not an agreement to pay for a service.
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Prior Authorized means a system that requires a Provider to get approval from SHL before providing non-emergency healthcare services to an Insured for those services to be considered Covered Services. Prior Authorization is not an agreement to pay for a service.
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Prior Authorized means a system that requires a Provider to get approval from SHL before providing non-emergency healthcare services to an Insured for those services to be considered Covered Services. Prior Form No. SHL AdultVisionRider IND (2014) Page 3 41NVSHLAOC_AdultVision_Ind_2014 Adult Vision Care Service Rider Authorization is not an agreement to pay for a service.
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Examples of Prior Authorized in a sentence

  • Benefits payable for expenses incurred in connection with Covered Services which are not Prior Authorized by SHL’s Managed Care Programwill be reduced to 50% of what the Insured would have received if the services had been Prior Authorized.

  • All benefits for Durable Medical Equipment (“DME”) includes administration, maintenance and operating costs of such equipment , if the equipment is Medically Necessary or Prior Authorized.

  • Benefits payable for expenses incurred in connection with Covered Services, which are not Prior Authorized by the Managed Care Program, will be reduced as shown in the Attachment A Benefit Schedule.

  • Covered Services include custom-made or custom-fitted Medically Necessary Corrective Appliances when Prior Authorized by SHL’s Managed Care Program, to include the following: • Rigid Cervical Collars; • Abdominal Binder/Corsets; • Shoes when prescribed for a diabetic condition, otherwise only when an integral part of a lower body brace; • Helmets when prescribed in connection with cranial orthosis.

  • Covered Services include Prior Authorized Medically Necessary Gastric Restrictive Surgical Services for extreme obesity under the following circumstances: • Have a body mass index(BMI) of greater than or equal to 40kg/m2; or • Have a BMI between 35.1- 39.9 kg/m2 with significant co-morbidities; and Certificate of Coverage • Can provide documented evidence that dietary attempts at weight control are ineffective; and • Must be at least 18 years old.

  • If the Insured receives services other than Emergency Services in a Mental Health or Severe Mental Illness facility without obtaining Prior Authorization from SHL, benefits will be reduced to 50% of what the Insured would have receivedif the services hadbeen Prior Authorized, provided however, that the benefits paid will not be les s than 50% of the Eligible Medical Expenses.

  • Benefits payable for Covered Services which are not Prior Authorized by SHL’s Managed Care Programwill be reduced to 50% of what the Insured would have received with Prior Authorization.

  • If the Insured receives services other than Emergency Services in a Substance-Relatedand Certificate of Coverage Addictive Disorder facility without obtaining Prior Authorization from SHL, benefits will be reduced to 50% of what the Insured would have receivedif the services hadbeen Prior Authorized, provided however, that the benefits paid will not be less than 50% of the Eligible Medical Expenses.

Related to Prior Authorized

  • Prior authorization means that we must approve the Services in advance in order for the Services to be covered.

  • Authorized “Directed” or “Approved” shall mean the authority, direction or approval of the Engineer.

  • former Authority means the Water Authority of Western Australia under the Water Authority Act 1984 2 before the commencement of Part 2 of the Water Agencies Restructure (Transitional and Consequential Provisions) Act 1995 3;

  • Work Authorization or "WA" means Buyer’s authorization in either electronic or tangible form for Supplier to conduct transactions under this Agreement in accordance with the applicable SOW (i.e., a purchase order, xxxx of lading, or other Buyer designated document). A SOW is a WA only if designated as such in writing by Buyer.

  • Prior Approval means written ap- proval by an authorized official evi- dencing prior consent.

  • Customer Application means a software program that Customer creates or hosts using the Services.

  • Expiry Date (Data di Scadenza) means the Expiry Date as specified in § 1 of the Product and Underlying Data.

  • Commercial Software means Software developed or regularly used that: (i) has been sold, leased, or licensed to the general public; (ii) has been offered for sale, lease, or license to the general public; (iii) has not been offered, sold, leased, or licensed to the public but will be available for commercial sale, lease, or license in time to satisfy the delivery requirements of this Contract; or (iv) satisfies a criterion expressed in (i), (ii), or (iii) above and would require only minor modifications to meet the requirements of this Contract.

  • Authorized pharmacist means an Iowa-licensed pharmacist whose license is in good standing and who meets the drug therapy management criteria defined in this rule.

  • Program Materials means the documents and information provided by the Program Administrator specifying the qualifying EEMs, technology requirements, costs and other Program requirements, which include, without limitation, program guidelines and requirements, application forms and approval letters.

  • Customer Proprietary Network Information (“CPNI”) is as defined in the Act.

  • Authorized entity means a nonprofit organization or a governmental agency that has a primary mission to provide specialized services relating to training, education, or adaptive reading or information access needs of blind or other persons with disabilities;

  • Authorized nuclear pharmacist means a pharmacist who:

  • Background Material means any pre-existing works in which the Intellectual Property Rights are owned by either Party, which have been prepared by that Party outside the scope of this Agreement or which were licensed from a third party by that Party.”