Existing Wording: Wording change - Prior authorization (PA) is performed in the United States by payers and providers to ensure that patients/members receive care and coverage of treatments, testing, referrals, devices appropriate for their specific conditions and the general coverage provided by the specific health plan in which the member is enrolled.

Proposed Wording: to: Prior authorization (PA) is performed in the United States by payers and providers to ensure that patients/members receive the care as appropriate for their specific condition and coverage of treatments, testing, referrals, devices appropriate as provided under the health plan in which the member is enrolled.

Summary:

Wording Change