Your doctor will need to ask Partnership for approval before you get certain types of care. This is called asking for prior authorization. Partnership must approve some medical services, medical tools and/or medical supplies before you get them. This means Partnership must make sure that the care or service is medically needed.
Your doctor will send us a Treatment Authorization Request form ("TAR") if you need something that needs prior authorization.
The following services always need prior authorization:
- Hospitalization when it is not an emergency
- Services out of the Partnership service area when it is not an emergency
- Outpatient surgery
- Long-term care or skilled nursing services at a nursing facility
- Specialized treatments, imaging, testing, and procedures
- Medical ride services when it is not an emergency. Emergency ambulance services do not need prior authorization.
TARs are reviewed by our medical staff (doctors, nurses and pharmacy staff). They review each case to make sure you are getting the best and right treatment for your medical condition.
We approve most TARs, but sometimes a TAR is delayed. This may happen if we need to ask the doctor for more information. We will let your doctor know if a TAR was approved, or if we need more information. Please check with your doctor, the Member Portal, or contact our Member Services Department to find out if your TAR has been approved or not.
We respond to all TARs within 5 business days after getting the request. If a treatment is urgent, we respond within 72 hours after getting the request.
Both you and the doctor will get a letter from us if we do not approve the request. This is called a notice of action (NOA) letter. The letter will tell you and your doctor that the TAR was denied and why. The NOA letter will also tell you how to file an appeal if you do not agree with the decision.
You can call our Member Services Department at (800) 863-4155 if you would like more information on how we make these decisions.