Prior Authorization

Prior Authorization is a mandatory process for certain healthcare services, requiring providers to obtain approval from Delaware First Health before proceeding with treatment. This process is crucial to ensure that the services provided are covered under the member's health plan. Failure to secure prior authorization can lead to administrative claim denials, with providers unable to charge members for services denied due to lack of authorization. Services that typically require prior authorization include advanced medical treatments and some outpatient programs, and authorization requests should be submitted within five days of admission.