Certain medications have a status of Prior Authorization Required (PAR). If your doctor wants to prescribe a PAR drug, he or she will submit a request for approval before the drug can be dispensed as a covered benefit. If your pharmacist receives notification that a drug you were prescribed requires prior authorization, ask your pharmacist to contact us.
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Credible Certificate of Coverage is required to prove prior coverage during a Qualifying Event. (Example: An employee loses coverage through his/her employer and now wants to be covered under the spouse’s plan. The CCOC will provide date coverage ended under prior carrier.)
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A referral to a non-participating specialty doctor may be obtained if a uniquely specialized procedure is medically necessary and not performed by any participating doctors. This process must be requested by the participating doctor and approved by PHP, in writing, prior to receiving the services. It is the member's responsibility to notify us of the initial appointment date, or a change to the date they were given by the physician.
If the visit results in a recommendation for further treatment such as therapy, durable medical equipment, additional testing or surgery, the member must notify us prior to receiving these services. The non-participating specialty doctor you were referred to should send claims associated with the visit to:
PHP
PO Box 2359
Fort Wayne, IN 46801-2359
After the visit, the non-participating specialty doctor should send the treatment plan summary to:
FAX: (260) 436-4809
Download a list of services requiring prior authorization.
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Open Enrollment is the period of time (usually one month prior to the group’s renewal) that is listed on the group contract that allows eligible employees who previously did not enroll, to come onto the plan and for those members enrolled to add, delete and/or make changes to their current coverage.
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