What is Prior Authorization?
Some medical services, surgical procedures, and medications require IHN-CCO’s approval before you can get them. This process is called Prior Authorization. It basically means that your provider has to ask permission to prescribe you a drug or have you undergo a treatment, service, or surgery that isn’t covered by your health plan.
How does it work?
Your provider fills out a form requesting permission to give you a certain drug, treatment, service, or surgery. If approved, it will be covered to some extent by IHN-CCO. If not, IHN may recommend an alternative that is covered, or you may opt to get the drug, treatment, service, or surgery anyway and cover the costs yourself.
What requires authorization?
IHN-CCO reviews and updates its Prior Authorization lists annually. For 2017, IHN-CCO requires Prior Authorization for the following:
InterCommunity Health Network CCO has the right to review or deny services that are not found to be< medically appropriate.
*Diabetic supplies that DO require approval: Insulin pumps, diabetic shoes/inserts.
*Diabetic supplies that DO NOT require approval: lancets, test strips, meters, syringes, and pump supplies.
Medically appropriate - Services and medical supplies that are needed for prevention, diagnosis or treatment of a physical or mental health condition, or injury, and which are:
Emergency services do not require prior approval. We do request notification of all emergency inpatient
For a complete list of services that require approval, please contact your dental plan directly.
Advantage Dental Services
1-866-268-9631, TTY 1-866-268-9617
Capitol Dental Care
1-800-525-6800, TTY 1-800-735-2900
Oregon Dental Services
1-800-342-0526, TTY 1-800-342-0526 x711
Willamette Dental Group
1-855-433-6825 option 3, TTY 1-800-735-1232