Prior Authorization Overview
Medi-Cal beneficiaries (patients) receive health care services from medical, pharmacy, or dental providers enrolled in the Medi-Cal Program. Providers must receive authorization from Medi-Cal in order to provide and/or be paid for some of these services. The form a provider uses to request authorization is called a Prior Authorization (PA). Your Medi-Cal provider will know how and when to complete and submit a PA.
PAs are used by Medi-Cal to help ensure that necessary medical, pharmacy, or dental services are provided to Medi-Cal recipients and that providers are reimbursed appropriately. PAs are confidential documents and the information included on them is protected by state and federal privacy laws.
After your medical, pharmacy, or dental provider has submitted a PA to Medi-Cal, he or she can check its status by phone or on the internet. Your provider will inform you if the PA was approved. If it was approved, no further action is required. If the PA was not approved, and you disagree with the decision, you may be able to request a fair hearing to determine if the decision should be changed. Information on your fair hearing rights is available online at the Medi-Cal Fair Hearing webpage.
