The Dean Advantage Prior Authorization Form below is to request authorization of services that require prior authorization, including medical drug injectables. Refer to the Dean Advantage Prior Authorization Medical Service List for services that require prior authorization and to submit prior authorization requests.
Dean Advantage Prior Authorization Form
Dean Advantage Prior Medical Services Authorization Service List
Dean Health Plan Medical Policies
Services will be reviewed according to the Medicare Coverage Guidelines, established by the Centers for Medicare & Medicaid Services (CMS). According to the guidelines, all medical care, services, supplies and equipment must be medically necessary.
In scenarios where CMS does not provide guidance on the particular medical care, service, supplies and equipment, Dean Health Plan will use MCG (formerly Milliman Care Guidelines) criteria or a Dean Advantage Medical Policy. Please refer to the Dean Advantage Medical Services Prior Authorization List to access the Dean Advantage Medical Policies relevant to the services you are requesting.
Additional Information regarding medical management can be found on the Dean Health Plan Medical Management page. Key resources include: