Referral Authorization

Prior Written VHP Authorization (Referrals)
PWVA is the authorization from VHP for a member to receive covered services from a provider other than a VHP network physician or as specifically described in the Benefits section of the member handbook.

VHP Authorization:

1. Is the responsibility of the Member
2. Must be requested by a VHP Network physician
3. Is obtained before the Covered Services are provided
4. Specifies the Provider to whom the Member has been referred
5. Specifies the duration and/or specifics of the Covered Services
6. Is approved in writing by our Medical Director

What Requires a Prior Written VHP Authorization?
Prior Written VHP Authorization (PWVA) is required to receive covered services from a provider other than a VHP Provider. There may be some services that require PWVA even when ordered or rendered by a VHP provider. For example, some durable medical equipment (hospital beds, wheelchairs, etc.); home care and nursing home stays; and certain tests or treatments. Please refer to your Benefit Handbook or call the Customer Relations Department for services requiring PWVA. Mayo Clinic in Rochester, Minnesota is not a Network Provider, therefore does require a PWVA. Authorization must be approved by VHP prior to services being done.

How do I get a Prior Written VHP Authorization?
You need to let your practitioner know you have VHP coverage when a PWVA is required. They will then send a request for authorization to VHP, which is reviewed by the VHP Medical Director. Generally, within two to three working days, a written response with the decision is sent to you, your VHP practitioner and the provider you are being referred to. You may contact our Customer Relations Department or Referral Coordinator with any questions regarding our authorization process or to check if VHP received a request for authorization.

How will I know what will be covered for those services requiring Prior Written VHP Authorization?
You will receive a written response from VHP. It will specify the duration and specifics of the approved covered service(s). You may also contact our Customer Relations Department or Referral Coordinator with any questions you have regarding the PWVA.