[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-288911-105":53,"doc-detail-288911-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","prior-authorization-process-and-services-overview","Prior Authorization - Process and Services Overview","","Prior authorization outlines when a health plan requires approval before certain medical services or treatments. It explains how in-network and out-of-network providers request authorization, notes that emergency services typically do not require prior authorization, and clarifies that approval is not a guarantee of coverage. The process includes evidence-based review, set timelines for decisions, requests for additional information, and instructions for appeal after denials, with separate rules for expedited urgent cases.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/prior-authorization-process-and-services-overview/288911/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/prior-authorization-process-and-services-overview/288911.png","ImageObject",442,249,{"name":88,"@type":89},"Evangeline","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-07","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is prior authorization and when is it required?","Question",{"text":109,"@type":110},"Prior authorization is approval needed from the health plan before certain services or treatments happen. Providers request it for covered services that require approval before care begins.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How long does the prior authorization process take?",{"text":114,"@type":110},"For non-urgent conditions, Providence decides within two business days after receiving the request. If additional information is needed, you have 15 calendar days to submit it, and Providence completes review within two business days after receiving the additional information.",{"name":116,"@type":107,"acceptedAnswer":117},"What are the rules for expedited prior authorization for urgent medical conditions?",{"text":118,"@type":110},"For urgent conditions, Providence notifies the provider within 72 hours after receiving the prior authorization request. If more information is needed, Providence requests it within 24 hours, and the provider has 48 hours to submit it, followed by a completion decision by the earlier of 48 hours after receipt or 48 hours after the information was due.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},288911,1790195270,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},13056703019662,"https://ap-avatar.wpscdn.com/avatar/be000253a8e92610077?_k=1778726343310543188","Prior authorization  \nA prior authorization is an approval you need to get from the health plan for some services or treatments before they occur. In-network providers will request any necessary prior authorization on your behalf. Out-of-network providers may not, in which case you will need to submit any needed requests for prior authorization. Emergency services do not require a prior authorization. See below for information about what services require prior authorization and how to submit a request should you need to do so.  \nPrior authorization is not a guarantee of coverage. Payment is based on eligibility and benefits at the time of service. If you or your provider fail to obtain a prior authorization when it is required, any claims for the services that require prior authorization may be denied.  \nThe prior authorization process  \nOur clinical team of experts will review the prior authorization request to ensure it meets current evidence-based coverage guidelines. For services that do not involve urgent medical conditions, Providence will notify you or your provider of its decision within two business days after the prior authorization request is received. If additional information is needed to process the request, Providence will notify you and your provider. We allow 15 calendar days for you or your Provider to submit the additional information. Within two business days of the receipt of the additional information, Providence will complete its review and notify you and your Provider of its decision. If the information isnot received within 15 calendar days, the request will be denied. A letter will be sent to you and your provider detailing the reason for the denial and explaining your appeal rights if you feel the denial was issued in error.  \nExpedited prior authorization  \nFor services that involve urgent medical conditions: Providence will notify your provider or you of its decision within 72 hours after the prior authorization request is received. If Providence needs additional information to complete its review, it will notify the requesting provider or you within 24 hours after the request is received. The requesting provider or you will then have 48 hours to submit the additional information. Providence will complete its review and notify the requesting provider or you of its decision by the earlier of (a) 48 hours after the additional information is received or, (b) if no additional information is provided, 48 hours after the additional information was due.  \nAuthorizations involving concurrent care decisions  \nProvidence will notify you if an approved ongoing course of treatment is reduced or ended because of a medical cost management decision. You may submit a request to reconsider that decision at least 24 hours before the course of treatment is scheduled to end. Providence will then notify you of its reconsideration decision within 24 hours after your request is received. You can make this request by either calling customer service or by writing the medical management team.  \nServices requiring prior authorization  \nBelow is a short list of commonly requested services that require a prior authorization. This is not a complete list. For a complete list of services and treatments that require a prior authorization click here. We recommend you consult your provider when interpreting the detailed prior authorization list.  \n• All inpatient hospital admissions (not including emergency room care)  \no In an emergency situation, go directly to a hospital emergency room. You do not need Prior Authorization for emergency treatment; however, we must be notified within 48 hours following the onset of inpatient hospital admission or as soon as reasonably possible.  \n• All hospital and birthing center admissions for maternity/delivery services  \n• Skilled nursing facility admissions  \n• Inpatient rehabilitation facility admissions  \n• Inpatient mental health and/or chemical dependency services  \n• Outpatient rehabilita","cbCaicuyGrNSC1Po","https://ap.wps.com/l/cbCaicuyGrNSC1Po","pdf",132356,"English","# Prior authorization\n## The prior authorization process\n## Expedited prior authorization\n## Authorizations involving concurrent care decisions\n## Services requiring prior authorization\n## Prior authorization requests for out-of-network services","[{\"question\":\"What is prior authorization and when is it required?\",\"answer\":\"Prior authorization is approval needed from the health plan before certain services or treatments happen. Providers request it for covered services that require approval before care begins.\"},{\"question\":\"How long does the prior authorization process take?\",\"answer\":\"For non-urgent conditions, Providence decides within two business days after receiving the request. If additional information is needed, you have 15 calendar days to submit it, and Providence completes review within two business days after receiving the additional information.\"},{\"question\":\"What are the rules for expedited prior authorization for urgent medical conditions?\",\"answer\":\"For urgent conditions, Providence notifies the provider within 72 hours after receiving the prior authorization request. If more information is needed, Providence requests it within 24 hours, and the provider has 48 hours to submit it, followed by a completion decision by the earlier of 48 hours after receipt or 48 hours after the information was due.\"}]","Prior Authorization - Process and Services Overview | PDF",1789634202]