Services requiring prior authorization
Prior authorization is a process though which Arkansas Blue Cross and Blue Shield
approves a request for a covered healthcare service before the member receives the
service from a provider. Prior authorization must be requested and approved before
the member to receives services. If not, the claim will be denied. Arkansas Blue
Cross and Blue Shield member contracts require prior authorization for the following:
This list is not exhaustive.
Denial of services with prior authorization
Arkansas Blue Cross will authorize coverage if medical necessity is supported. However,
a request for prior authorization, if approved, does not guarantee payment. A claim
receiving prior authorization as a pre-service claim must still meet all other coverage
terms, conditions and limitations. Coverage for any such pre-service claim receiving
prior authorization may still be limited or denied if investigation shows that:
If no additional information is requested, you will be notified of the determination
in no later than two business days from the date the pre-service claim was received.
Additional information regarding medical necessity and prior authorization can be
found in the member contract.
Prior authorization is a process required for specified dental procedures before
they are performed. Typically the dental or healthcare provider will obtain this
preauthorization for the insured, but it is your responsibility to ensure the preauthorization
is obtained before the services are performed. Services that are not preauthorized
when required are not payable by USAble Mutual Insurance Company and will be the
Timeframes and required documentation for prior authorization requests
Requests for preauthorization of benefits should be submitted within thirty (30)
days of the date of the initial diagnosis or exam. The dentist or healthcare provider
or the insured must submit for the Company's review, x-rays, a complete treatment
plan, and in some cases, more substantiating material such as a study model.
Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas.
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