Prior Authorization Requirements for Health Services

This document is a guide detailing the prior authorization requirements for the Plan de Salud Menonita – Vital. It specifies that all non-par providers require authorization for various services, including office visits, surgical procedures, labs, diagnostic studies, and inpatient stays, except in emergencies. The guide notes that no prior authorization is needed for emergency services and emphasizes that the absence of a code from the list does not indicate whether a service is covered. It clarifies that prior authorization does not guarantee payment, which is contingent on the member's eligibility, benefit limitations, and applicable standards during claim review. The document outlines specific services requiring prior authorization, including surgery, medical procedures, radiology, genetic tests, outpatient rehabilitation therapy, and durable medical equipment. It also mentions that the list is subject to periodic changes and advises providers to verify the information regularly.