Prior Authorization (Part C)
What is Prior Authorization?
Prior authorization means that you must get approval from Buckeye Health Plan – MyCare Ohio (Medicare-Medicaid Plan) before you can get a specific service or drug or see an out-of-network provider. Buckeye Health Plan may not cover the service or drug if you don’t get approval. If you need urgent or emergency care or out-of-area dialysis services, you don't need to get approval first.
Which services require Prior Authorization?
To get a list of services that require prior authorization, please contact Buckeye Health Plan – MyCare Ohio at 1-866-246-4359 (TTY: 711).
For out-of-network services you must get prior authorization. You do not need prior authorization for emergencies. Out-of-area urgent care or dialysis does not need prior authorization.
What is the process for getting Prior Authorization?
You may get by calling Buckeye Health Plan – MyCare Ohio at 1-866-246-4359 (TTY: 711).
Providers need to send prior authorizations through the web portal, by phone or by fax.
You will be told if we approve the service before 72 hours after we get your request. This is what we call a Fast decision (Expedited).
You will be told no later than 14 calendar days for all other requests.
If we find that your health may be in danger we will hurry your request.
We will tell you what we decide in writing or by telephone. In the case of an emergency, you do not need prior authorization.
Prior authorization is not a promise of payment. The plan has the right to review the service for medical need after you receive the services. The member must be eligible for services. Some services have limits. Some benefits have exclusions.