RN Case Manager Prior Authorizations

Will be requesting prior authorization of durable medical equipment for members.

100% Telephonic

Requests for prior authorization of DME

Review provider requests through fax or telephone to ensure medical necessity for services requiring pre-authorization

Utilize nationally recognized criteria to determine medical necessity of services requested

Refer provider requests appropriately to Medical Director when medical necessity of services is not met based on the criteria

Data enters authorizations into the system