We do not require prior authorization for any procedures, however, CareGuard is only able to pay for claims that are related to the member’s injury and Medicare compliant. Additionally, a member is not guaranteed to have funds to cover a procedure just because they have coverage (please see what to do if you receive a funds exhausted EOR) We always recommend obtaining authorization from secondary insurance as back up and encourage you to speak with your patient about their fund status if you have any concerns. CareGuard is unable to provide any fund amount to you directly.
Please be advised, CareGuard only provides prior authorizations for relatedness, compliancy, and fund availability. We do not perform prior authorizations based on medical necessity.