What is a prior authorization?
Community Health Choice members have access to all covered benefits that are medically necessary health care services. Some of these services need to be reviewed before the service is provided to make sure the service is appropriate and medically necessary. This review is called prior authorization, and is made by doctors, nurses and other health care professionals.
If a prior authorization request cannot be approved based on medical necessity, you will receive a letter with the reason why the prior authorization request was not approved. This is called a denial. You can ask Community Health Choice to review the denial again. This is called an appeal.
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