When a service requires authorization, the information submitted on the claim must match the information on the authorization request, including the procedure codes, modifiers, units, and dollar amounts authorized. The authorization number is not required on the claim submission.
Bill authorized and unauthorized services on separate claims. If authorized services are billed on the same claim as unauthorized services, the claim will deny. When a member has other health insurance coverage, authorization and other rules that apply to the primary insurance must also be followed.
An approved authorization does not guarantee payment; all other PrimeWest Health requirements must be met.
For more information about authorizations, please see Authorizations under Member Benefits & Services.