Prior Authorization Service Types Addendum
BY ENTERING INTO AN ORDER UNDER WHICH CUSTOMER WILL BE PROVIDED PRIOR AUTHORIZATION SERVICES WHICH ARE PRICED BY SERVICE TYPE, CUSTOMER HEREBY ENTERS INTO THIS PRIOR AUTHORIZATION SERVICE TYPES ADDENDUM (THIS “ADDENDUM”) AND IS LEGALLY BOUND THEREBY. FOR THE AVOIDANCE OF DOUBT, THIS ADDENDUM DOES NOT APPLY TO THE PROVISION OF ANY PRIOR AUTHORIZATION OR OTHER SERVICES NOT PRICED BY SERVICE TYPE. THIS ADDENDUM IS HEREBY ATTACHED TO AND MADE A PART OF THE GENERAL TERMS AND CONDITIONS (“GENERAL TERMS”) SET FORTH AT HTTPS://WWW.INFINX.COM/TERMS-AND-CONDITIONS-FOR-CUSTOMER-AGREEMENTS BY AND BETWEEN THE CONTRACTING INFINX ENTITY PROVIDER DESIGNATED IN THE APPLICABLE ORDER(S) ON BEHALF OF ITSELF AND ITS AFFILIATES (INCLUDING WITHOUT LIMITATION, ITS OFF-SHORE AFFILIATES WHICH INCLUDE INFINX SERVICES PVT. LTD., LOCATED IN INDIA AND INFINX HEALTHCARE PHILIPPINES, INC., LOCATED IN THE PHILIPPINES) (COLLECTIVELY, “INFINX”), AND THE PURCHASING BUSINESS OR OTHER ENTITY WHO IS ENTERING INTO THE ORDER(S) (“CUSTOMER”), REGARDING THE PROVISION AND USE OF PRIOR AUTHORIZATION SERVICES PRICED BY SERVICE TYPE. THE PERSON EXECUTING THE ORDER(S) ON BEHALF OF CUSTOMER REPRESENTS AND WARRANTS TO INFINX THAT THEY HAVE FULL LEGAL AUTHORITY TO ACCEPT THE TERMS OF THIS ADDENDUM AND THAT THEY AND CUSTOMER ARE NOT BANNED FROM USING THE PROVIDED SERVICES UNDER THE LAWS OF THE UNITED STATES OR ANY OTHER COUNTRY. ALL CAPITALIZED TERMS USED IN THIS ADDENDUM BUT NOT DEFINED WILL HAVE THE SAME MEANINGS GIVEN IN THE GENERAL TERMS OR APPLICABLE ORDER. IN THE EVENT OF A CONFLICT BETWEEN THE TERMS OF THIS ADDENDUM, THE GENERAL TERMS AND THE ORDER, THE FOLLOWING DESCENDING ORDER OF PRECEDENCE WILL CONTROL: THE ORDER, THIS ADDENDUM AND THE GENERAL TERMS.
Prior Authorization Service Types: The Prior Authorization service types are as follows:
Service Type | PA Type |
---|---|
Surgical (includes Urology, Vascular and Vein Surgery) | PA II |
Diagnostic X-Ray | PA I |
Diagnostic Lab | PA II |
Radiation Therapy | PA II |
MRI Scan | PA I |
Pathology | PA II |
Chemotherapy | PA II |
Allergy Testing | PA I |
Podiatry | PA II |
Occupational Therapy | PA I |
Speech Therapy | PA I |
Skilled Nursing Care (Home Health) | PA II |
Orthopedic | PA I |
Cardiac – Mobile Cardiac Telemetry | PA I |
Cardiac – Event Monitor | PA I |
Cardiac – Extended Holter | PA I |
Cardiac – Holter | PA I |
Cardiac – all not listed above | PA II |
Gastrointestinal | PA II |
Neurology | PA II |
Coronary Care | PA II |
Mammogram, High Risk Patient | PA I |
Durable Medical Equipment | PA II |
CAT Scan | PA I |
Ophthalmology | PA II |
Allergy | PA II |
Oncology | PA II |
Positron Emission Tomography (PET) Scan | PA I |
Physical Therapy | PA I |
Pediatric | PA II |
Specialty Pharmacy | PA II |
Other (any service type or specialty not listed) | PA II |
Prior Authorization Service Types Addendum to General Terms and Conditions, Version 1.0, Promulgated February 5, 2025.