Prior Notification

90.3 – Prior Notification (Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11) Under prior notification, a plan reduces its standard cost sharing levels when the provider from whom a member is receiving plan-covered services voluntarily notifies the plan prior to furnishing those services, or the member voluntarily notifies the plan prior to receiving plan-covered services from a provider. PFFS plans may not require members or providers to prior notify the plan as a condition of coverage nor can PFFS plans establish voluntary prior notification rules.