Community Care Plan | AI Prior Authorization & RCM Automation

Community — illustration for prior authorization and payer guidance on Prior Auth Space

Insurer Name : Community Care Plan
Address : 1643 Harrison Parkway, Suite H-200, Sunrise, FL 33323
Phone Number : 1-866-930-0944
Website : https://ccpcares.org

Medicare/Medicaid/TRICARE Support : Yes (Medicaid)
Specific Plans Offered : MEDICAID (MMA), FLORIDA HEALTHY KIDS, COMMERCIAL, SELF-INSURED EMPLOYEE HEALTH PLANS

Frequently Asked Questions:

What is pre-authorization in healthcare?

Pre-authorization, also known as prior authorization, is the process of getting approval from a health insurance provider before a specific medical service, procedure, or medication is provided to ensure coverage.

When is pre-authorization required?

Pre-authorization is typically required for services like elective surgeries, advanced imaging (MRI, CT scans), specialized treatments, and certain prescription medications. Requirements vary by insurance plan.

How do I check if a service needs pre-authorization at CHS?

You can verify pre-authorization requirements by checking with your insurance provider, reviewing your plan details, or contacting the CHS facility where you’re receiving care.

What happens if pre-authorization is not obtained?

If pre-authorization is not secured, your insurance provider may deny coverage, making you responsible for the full cost of the service.

How long does the pre-authorization process take?

The timeline varies but generally takes a few days to a few weeks, depending on the complexity of the request and the responsiveness of the insurance company. Urgent cases may be expedited.

Who is responsible for obtaining pre-authorization?

Typically, the healthcare provider’s office submits the pre-authorization request, but it is the patient’s responsibility to ensure it has been approved before receiving the service.