Prior Auth Required

20265 - B. National Committee for Quality Assurance (NCQA) Guidelines (Effective July 1, ) UM 2 Clinical

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceB. National Committee for Quality Assurance (NCQA) Guidelines (Effective July 1, ) UM 2 Clinical
Procedure / Service Description

Management Program, Prior Authorizations and Review Procedures - A. Department of Health Care Services (DHCS) Contract Exhibit A, Attachment III, 2.3.1. Utilization Management Program, Prior Authorizations and Review Procedures B. National Committee for Quality Assurance (NCQA) Guidelines (Effective July 1, 20265) UM 2 Clinical Criteria for UM Decisions, Element C, Factors 1 and 2 C. Department of Health Care Services (DHCS) Intergovernmental Agreement for Drug Medi-Cal

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.