Pre-authorization refers to the process where an insurer approves medical
services based on medical necessity prior to services being provided.
Determining a pre-authorization requirement is the responsibility of the
ordering physician or patient. If the procedure requires pre-authorization,
the Office of Inspector General (OIG) acknowledges the ordering physician
has the responsibility of acquiring approval for the service.
Each payer may have its own requirements for which party has the responsibility
to initiate a pre-authorization – the referring or primary care
physician. Many payers do not allow the servicing facility to obtain a
pre-authorization. The provider who orders any testing has access to the
patient’s medical history and supporting documentation proving medical
necessity. This information is often required to obtain a pre-authorization.
Campbell County Health believes that obtaining a pre-authorization is the
responsibility of the ordering provider, as part of providing care to
the patient.
To assist in this process, please refer to the list of common insurance
companies in the servicing area below. For more information, please call
307-688-1142.
Disclaimer: This may not be a complete list of all payer authorization
requirements. All information is subject to change. An updated list is
posted monthly. To obtain access to a payer website, please contact your
system administrator for enrollment. For more information, please call
307-688-1142.
