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Home|Providers|Authorizations

Authorizations

Certain specialized services and prescription drugs require a prior authorization or inpatient notification before being rendered to patients and members. Prior authorizations and inpatient notifications ensure that patients are receiving the right amount of medically necessary care in the right setting for the insurance plan for which they're enrolled.

Medical

Prior Authorization Guide Intel Connected Care Prior Authorization Grid Prior Authorization Request Form Centennial Care Prior Authorization Request Form Durable Medical Equipment (DME) Prior Authorization Request Form Referral Form: Care Coordination/Case Management/Disease Management Criteria for Total Hip Replacement (Checklist) Criteria for Total Knee Replacement (Checklist)

Pharmacy

Advanced Imaging Ordering Program

Presbyterian uses the Medical Specialty Solutions (MSS) program, managed by National Imaging Associates, Inc. (NIA), for prior authorizations of both non-emergent, advanced diagnostic imaging procedures and cardiac-related imaging procedures performed in an outpatient setting. The program is designed to streamline the authorization process, reduce healthcare costs, and improve patient outcomes. The documents below provide additional information about the MSS program. If you have any questions or concerns about the program, please contact your Provider Network Management relationship executive.

Submit a prior authorization to the MSS program

 

Behavioral Health