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These include non-elective, inpatient admissions, including those which might be subsequent to emergency services and stabilization of the patient, which do not require prior authorization. Physical and behavioral health emergencies, life threatening situations and post-stabilization services do not require prior authorization. For some companies, utilization evaluation is critical to determine the medical necessity and appropriateness of a covered health care service for Superior HealthPlan’s managed care members. For these companies, utilization evaluate is performed before , throughout or after the service is delivered. However, situations affecting the brain and nervous system normally emerge …
