For authorization, ask: “Does this service require prior authorization, pre-certification, notification, concurrent review, or a referral?” Then ask who submits the request, what information is required, when it must be submitted, and whether approval covers dates, units, or a review period. An authorization is not a guarantee of payment. Claims may still depend on eligibility, coding, network rules, plan exclusions, and the terms in force when service occurs.
For network status, give the insurer the legal entity name, address, and California record number. Ask whether Living Longer Recovery, Inc. at 68257 Calle Azteca is in network for the member’s exact plan and the specific service under discussion. Ask the facility what it can confirm, but treat insurer confirmation as a separate step. A provider may participate with one product from an insurer but not another, and network status may vary by location or service.
- Ask whether authorization is required before services begin and whether continued review may be required.
- Ask whether the facility, location, and relevant service are each in network for the exact plan.
- Write “needs review” beside any answer based on a pending clinical or contracting check.