Medical management for SSM employees

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For specific information, contact WellFirst Health Customer Care Center at 877-274-4693

Understanding prior authorization

As you navigate your health care, it’s important to note there are certain medical services or provider visits that require prior authorization by WellFirst Health. The prior authorization process can take up to 14 business days from the date your primary care provider (PCP) or specialty physician submits the prior authorization request. Medically urgent authorizations, as determined by your physician, are handled as a priority. Below is a process to help you determine if you need a prior authorization.

Do I need a prior authorization?

To determine whether you need to obtain a prior authorization for a service or procedure, follow the steps below.

Determine what type of insurance plan you have

Confirm your plan type by referring to your member ID card.

Note: Your self-funded plan coverage may have some differences that are not outlined below. You can find a list of services that require prior authorization in your summary plan document (SPD), or by contacting Customer Service. You can reach Customer Service at the telephone number listed on your ID card or by calling 877-274-4693 (TTY: 711).

Is it covered?

Keep in mind, a prior authorization can only be obtained for services that are covered under your plan benefits. For example, if acupuncture is an exclusion of your policy, a prior authorization will not change that benefit. If the services are covered under your plan, they are also still subject to any applicable cost sharing (i.e. copays, co-insurance or deductibles).

Prior authorization forms