Preauthorization of Services

Preauthorization allows us to review and determine the medical necessity of a service, drug and/or the appropriateness of the setting. Preauthorization is required or recommended (based on the plan) for a number of services, non specialty and specialty drugs as noted in our policies.

In addition, we recommend preauthorization for all elective inpatient admissions and before services are performed outside the local participating provider network. Failure to obtain preauthorization may result in your financial liability for all or part of the cost of services if the services are determined not medically necessary, experimental, or investigatory.

Below is a list of some of the most common services requiring preauthorization or notification.

Non-Radiologic Services

The services below require preauthorization:

  • Inpatient acute medical facility admissions
  • Acute rehabilitation facility admissions
  • Services obtained outside the local participating provider network

The service below requires notification only:

  • Skilled nursing facility admissions

To obtain preauthorization, please contact the Acute Care Coordination Department:

Call (401) 272-5670 or 1-800-635-2477 (outside of Rhode Island only).

Fax your request to (401) 272-8885.

Radiology Services

  1. Determine if you need preauthorization for radiology services.
  2. If you need preauthorization, please contact MedSolutions in one of three ways:

Get immediate approval by submitting your request at www.medsolutionsonline.com.

Call 1-888-233-8158 from 8:00 a.m. to 9:00 p.m., Eastern Standard Time, Monday through Friday.

Get a form at www.medsolutionsonline.com and fax it to
1-888-693-3210.

To learn more, download this fact sheet Ways to Obtain Priorauthorization for Radiologic Services

Behavioral Health Services

Preauthorization is recommended for the following services:

  • Inpatient mental health and chemical dependency
  • Acute substance abuse residential services
  • Partial hospital program
  • Intensive outpatient program
  • Child/family intensive treatment and adult intensive treatment services

To obtain preauthorization, please call (401) 274-4848 or 1-800-230-9050.

 

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