Kernfamilyhealthcare Prior Authorization Lookup
Latest Kernfamilyhealthcare prior authorization updates15
- Prior AuthReimbursement/Payment PolicyEff. 2022-07-01DAW 1 Coding and Reimbursement RatesDefines how claims identified with Dispense as Written 1 (DAW 1) are reimbursed for multisource brand drugs and the role of prior authorization and member claim history; applies to pharmacy providers submitting claims for Kern Family Health Care members.All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2020-09-11Formulary and utilization guidance for diabetic medications and suppliesDescribes preferred insulin and non-insulin diabetes medications, substitution guidance, step therapy and prior authorization expectations, and supply limits for Kern Family Health Care providers and pharmacies.All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2020-03-10COVID-19 screening and testing coveragePolicy states that Kern Family Health Care will cover medically necessary screening and testing for COVID-19 for its members and that prior authorization is not required for these services.All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-01ICD-10 overrides for prescription processingDefines specific ICD-10 diagnosis codes that will automatically allow point-of-sale claims for listed medications without prior authorization for Kern Family Health Care members; applies to providers submitting pharmacy claims to the plan.All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2019-12-16Pen needles and insulin syringes coverageThis policy governs coverage, prior authorization, and quantity limits for pen needles and insulin syringes for Kern Family Health Care members, and describes preferred products and how claims will be processed by the PBM. It applies to providers submitting requests for these supplies.All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2019-10-01Formulary and prior authorization guidance for diabetic medicationsThis document communicates formulary preferences, step therapy and prior authorization requirements for various diabetes medications and related supplies for Kern Family Health Care members; it is addressed to providers and pharmacies.All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2018-01-01Palliative Care — Coverage Criteria and Prior AuthorizationDefines coverage and eligibility criteria for palliative care services for Kern Family Health Care (KFHC) members and explains prior authorization process for providers.All kernfamilyhealthcare updates
- Prior AuthAdministrative/Operational PolicyEff. 2017-12-01Prior authorization when KHS is secondary payerStates Kern Family Health Care's rules for prior authorization when KHS is the secondary insurer; explains when prior authorization is not required and lists exceptions that still require prior authorization. Affects providers submitting claims for members with other primary insurance (including Medicare).All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2017-08-21Varicose vein procedures prior authorizationThis document governs prior authorization and documentation requirements for varicose vein procedures for Kern Family Health Care members under Medi‑Cal, affecting contracted providers who perform venous procedures.All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicyApplied Behavior Analysis (ABA) / Behavioral Health Treatment (BHT) services coverage criteriaDefines coverage and prior authorization guidance for medically necessary Behavioral Health Treatment (BHT) services, including ABA, for eligible Kern Family Health Care members (primarily beneficiaries under 21) and guidance for providers on submitting requests.All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicyDiabetic medication formulary and prior authorization guidancePolicy provides formulary preferences, step therapy and prior authorization directions for insulin and diabetic medications for Kern Family Health Care providers and pharmacies.All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicyNDC directory guidance and prior authorization for Firvanq (reconstituted/compounded products)Guidance for providers on coverage and prior authorization requirements related to non‑FDA approved reconstituted/compounded oral suspensions and the FDA‑approved product Firvanq; applicable to Kern Family Health Care Medicaid funds and provider prior authorization processes.All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicyOutpatient diabetes medication formulary, step therapy, prior authorization, and supply limitsThis document describes Kern Family Health Care's preferred manufacturers, step therapy and prior authorization expectations, and supply limits for outpatient diabetes medications and related supplies for providers and pharmacies.All kernfamilyhealthcare updates
- Prior AuthAdministrative/Operational PolicyPrior authorization rules for Medicare Part B office/outpatient servicesGovernance of prior authorization for Kern Family Health Care (KHS) members who have Medicare as their primary insurance, limited to office and outpatient services and affecting providers submitting those claims.All kernfamilyhealthcare updates
- Prior AuthClinical/Medical PolicySpecialty Nutrition Consultation / Medical Nutrition Therapy (MNT)Defines Kern Family Health Care coverage and procedures for referral to contracted Registered Dietitians to provide Medical Nutrition Therapy (MNT) for medically high-risk members on a case-by-case basis; describes services that do not require prior authorization.All kernfamilyhealthcare updates
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Tool Description
Search Kernfamilyhealthcareprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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