Prior Authorization

MediGold

MediGold requires prior authorization on select services. MediGold's Health Services department and delegated partners handle prior authorization for our valued providers. Please review all information below to find the correct information by year and area. MediGold Prior Authorization List 

  • Bariatric surgery
  • BRACAnalysis®  Large Rearrangement Test (BART™)
  • Hospital admissions (medical, surgical, behavioral health and rehabilitation)
  • Hyperbaric oxygen chamber treatment
  • Out-of-network care (HMO members only)
  • Power mobility devices
  • Skilled nursing (notification only)

Access MediGold Prior Authorization Request Forms  

HealthHelp

HealthHelp performs prior authorization for cardiology services, medical oncology, radiology and radiation oncology. The CPT codes requiring prior authorization can be found at the HealthHelp CPT List link below.         

Notifications to Members

Integrated Denial Notice (IDN):

MediGold must issue a written notice to an enrollee, an enrollee's representative, or an enrollee's physician when it denies a request for payment or services. The IDN combines and replaces the standardized Medicare Part C denial notices entitled "Notice of Denial of Payment" and "Notice of Denial of Medical Coverage." 

For more information on prior authorization, please see our Provider Administrative Manual on this website.


        Updated 01/2018