Some medical services and treatments require prior authorization before your appointment. If your provider recommends you have a certain type of treatment that requires prior authorization, the provider is responsible for getting authorization from Paramount Advantage.
The review process between your Paramount Advantage medical provider and the Utilization Review Department can be completed easily by fax or phone. Paramount Advantage will make a decision within seven (7) calendar days of receipt. An approval notice will be mailed to the provider within three working days of the determination. If the medical service requested is denied, you also will be notified by mail at the same time the decision is made.
If the medical service needed is an urgent request from your medical provider, a rush decision can be requested. Decisions will be made within 48 hours of receipt of the request. Requests for drugs given out directly by your medical provider will be decided in 24 hours.
Here is a list of medical services that need prior authorization or a prescription from your doctor. This is only a partial list of covered services. If you need additional information, please contact Member Services toll-free at 800-462-3589. TTY users can call 888-740-5670.