Prior Authorization

CHP’s Prior Authorization Team ensures services are medically necessary. It is not about preventing care, it is about providing appropriate care.

When a medical request is submitted by a facility, the Prior Authorization Team reviews the request along with the patient's medical record, current clinical presentation, and treatment provided to date. Then: in collaboration with CHP’s medical director, they determine if off-site care is appropriate. They make this decision by comparing medical requests to national and community standards of care. This is a cost-effective way to ensure the patients and our clients are getting the right level of care.