Employer PowerPoint Presentation - ETF

• Prior Authorization (PA)
• Designed to promote necessary care
• Intended to engage provider and patient in a discussion of best course of
treatment (e.g. alternatives to surgery; effects of repeated exposure to
radiation)
• Member responsible for finding out health plan’s PA process
▪
Types:
▪ Patient asks Dr. for PA
▪ Dr. asks health plan for PA
▪ “passive” PA systems – diagnosis code driven
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