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(NIA) Authorization Process for Expedited Urgent Requests........ 14  \nRadMD Access for Ordering Providers to Request Prior Authorization  15  \nRadMD for Ordering and Imaging Providers  17  \nRadMD Quick Start Guide  18  \nRadMD New Upload Feature  21  \nPrior Authorization Information RadMD  23  \nProvider Resources for Pharmacy Authorizations Commercial  24  \nCase Management and Care Coordination  25  \nCase Management/Care Coordination Referral Form  27  \nHealth Net Commercial Members Nurse Advice Line  28  \nAppeals & Grievances Provider Contact Information  29  \nEffective: January 1, 2019 (Revised July 1, 2019 )  \nOregon/Washington  \nAuthorization Requirements  \nHealth Net Health Plan of Oregon, Inc. (Health Net)  \n􀁸 EPO 􀁸 PPO  \n􀁸 Point of Service (POS) 􀁸 CommunityCare  \nAll services are subject to benefit plan coverage, member eligibility, and medical necessity in order for any plan benefit to be a covered service, irrespective of whether prior authorization is required. When faxing a request, please attach pertinent medical records, treatment plans, and test results to support the medical appropriateness of the request. Health Net reserves the right to review utilization patterns retrospectively and to address adverse trends with providers.  \nThis prior authorization list contains some services that require prior authorization and is not intended to be a comprehensive list of covered services. The member’s plan contract or Evidence of Coverage (EOC) provides a complete list of covered services. Plan contracts and EOCs are available to members on the member portal at [www.healthnet.com](www.healthnet.com) or in hard copy on request. Providers may obtain a copy of a member’s plan contract or EOC by requesting it from the Health Net Customer Contact Center or by visiting [https://www.healthnet.com/portal/provider/home.ndo](https://www.healthnet.com/portal/provider/home.ndo). Referrals to participating specialists – Providers are not required to obtain prior authorization from Health Net for referrals to Health Net participating specialists. This does not change the requirement that EPO, Triple Option/POS or CommunityCare members must coordinate their care through their primary care physicians (PCPs) .  \nUnless noted differently, all services listed below require prior authorization from Health Net. Refer to Prior Authorization Contacts for submission information. Providers can refer to the member’s Health Net identification (ID) card to confirm product type. For reference, CommunityCare is abbreviated CC.  \nPage 1 of 8  \nHN_ZZ25V3NR Revised 7/1/2019  \n\n| INPATIENT SERVICES |  | Commercial\u003Cbr>EPO, POS, PPO, CC |\n| --- | --- | --- |\n|  Behavioral Health or Substance Abuse Facility  Authorized by MHN |  | X |\n| Hospice\u003Cbr>Hospital | Acute inpatient admission and elective surgeries, inpatient\u003Cbr>rehabilitation, Long Term Acute Care Hospital (LTAC) | X\u003Cbr>X |\n| \u003Cbr>Skilled Nursing Facility |  | X |\n| Urgent/Emergent Admission | Notification required no later than 24 hours or by the next\u003Cbr>business day | X |\n| OUTPATIENT PROCEDURES, SERVICES OR EQUIPMENT |  | Commercial\u003Cbr>EPO, POS, PPO, CC |\n|  Ambulance  Fixed-wing aircraft – Non emergent |  | See EOC |\n| \u003Cbr>Balloon Sinuplasty |  | X |\n| \u003Cbr>Bariatric Procedures |  | X |\n| Behavioral Health and Substance Abuse | 􀁸 Authorized by MHN\u003Cbr>􀁸 Includes but is not limited to, neuropsych testing ordered\u003Cbr>by a","cbCaidqmhTBAXiyG","https://ap.wps.com/l/cbCaidqmhTBAXiyG","pdf",3783598,"English","# Authorization Requirements\n## Authorization Contact Information\n## Health Net Oregon Commercial Plan Request for Prior Authorization\n## Health Net Mental Health Services Information: Mental Health Network\n## Mental Health Network (MHN) Prior Authorization List\n## Health Net High-tech Imaging and Supporting Information: National Imaging Associates and RadMD\n## National Imaging Associates, Inc. (NIA) Authorization Process for Expedited Urgent Requests\n## RadMD Access for Ordering Providers to Request Prior Authorization\n## RadMD for Ordering and Imaging Providers\n## RadMD Quick Start Guide\n## RadMD New Upload Feature\n## Prior Authorization Information RadMD\n## Provider Resources for Pharmacy Authorizations Commercial\n## Case Management and Care Coordination\n## Case Management/Care Coordination Referral Form\n## Health Net Commercial Members Nurse Advice Line\n## Appeals & Grievances Provider Contact Information","[{\"question\":\"哪些服务通常需要在 Health Net 商业计划下进行事前授权？\",\"answer\":\"指南指出，除特别注明外，列表中所示服务均需要 Health Net 的事前授权。并提示该清单包含部分需事前授权项目，完整覆盖范围以成员计划合同或 EOC 为准。\"},{\"question\":\"提交事前授权请求时需要附哪些支持材料？\",\"answer\":\"传真请求时需附上相关医学记录、治疗计划以及检验结果，以证明请求的医学适当性。同时文件说明 Health Net 可在事后回顾审查利用模式并处理不良趋势。\"},{\"question\":\"精神健康与高科技影像授权分别通过哪些流程或系统处理？\",\"answer\":\"精神健康服务由 MHN 授权流程管理，包含 MHN 事前授权列表。高科技影像相关授权涉及 National Imaging Associates(NIA) 的流程以及 RadMD 系统（含快速入门与新上传功能）。\"}]","2019 Prior Authorization and Appeals Guide - Commercial | PDF",1789620424]