Question: How Can I Speed Up My Prior Authorization?

How long does prior authorization take Blue Cross Blue Shield?

24 to 72 hoursHow long is the review process.

A prior authorization decision may take up to 24 to 72 hours.

How do I check the status of a prior authorization request.

You can call the Member Services phone number on your member ID card from 7 a.m.

to 7 p.m.

Pacific time, Monday through Friday, or you can call your doctor’s office..

Why do prior authorizations exist?

There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic alternative, or checking for drug interactions.

How long does a prior authorization usually take?

Typically within 5-10 business days of hearing from your doctor, your health insurance company will either approve or deny the prior authorization request. If it’s rejected, you or your doctor can ask for a review of the decision.

How can I make prior authorizations easier?

5 tips for making prior authorizations less burdensomeKnow your triggers. Cantrell suggests avoiding the problem if at all possible. … Have a designated hitter. Smart use of staffing can help, too. … Go electronic. Some practices keep pre-written templates on hand for commonly used drugs or procedures, and that can save a lot of time. … Customize your EHR. … Keep patients in the loop.

What services typically require prior authorizations?

The other services that typically require pre-authorization are as follows:MRI/MRAs.CT/CTA scans.PET scans.Durable Medical Equipment (DME)Medications and so on.

Most payer-physician contracts prohibit charging such fees, but if the patient is out-of-network “they (the physician) have no contractual relationship with the plan. … Some specialists try to avoid prior authorizations by referring the patient back to the PCP to obtain a prior authorization.

How do I get a prior authorization from Medicare?

You can also telephone your Medicare Part D prescription drug plan’s Member Services department and ask them to mail you a Prior Authorization form. The toll-free telephone number for your plan’s Member Services department is found on your Member ID card and most of your plan’s printed information.

How do I get insurance to cover my medication?

If your insurance doesn’t cover your medication, there are a few alternative options to explore. You can ask your doctor for an ‘exception’ based on medical necessity, request a different medication from your doctor which is covered by your insurance, pay for the medication yourself, or file a written formal appeal.

How do I check prior authorization status?

How do I check the status of a prior authorization request? You can call the Member Services phone number on your member ID card from 7 a.m. to 7 p.m. Pacific time, Monday through Friday, or you can call your doctor’s office.

Who is responsible for prior authorization?

Health care providers usually initiate the prior authorization request from your insurance company for you. However, it is your responsibility to make sure that you have prior authorization before receiving certain health care procedures, services and prescriptions.

Why do prior authorizations get denied?

Insurance companies can deny a request for prior authorization for reasons such as: The doctor or pharmacist didn’t complete the steps necessary. Filling the wrong paperwork or missing information such as service code or date of birth. The physician’s office neglected to contact the insurance company due to lack of …

Can pharmacists do prior authorizations?

If a prescription is brought to the pharmacy that requires prior authorization, pharmacists can enter into the system, receive the pre-populated form, and then send it to the call center.

What does pre authorization mean for prescriptions?

What is prior authorization? This means we need to review some medications before your plan will cover them. We want to know if the medication is medically necessary and appropriate for your situation. If you don’t get prior authorization, a medication may cost you more, or we may not cover it.

Why do insurance companies deny prescriptions?

Another thing to consider is that your plan may impose quantity restrictions, which means that it will only cover certain amounts of a prescription. If your doctor is prescribing at doses higher than normal, the prescription may be denied.

What is the process for a prior authorization?

Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.