Lack of Information (LOI) Policy
Customize your policy alerts
Sign up for Aloha Care Policy RXMP-35 alerts
Get alerted when Policy RXMP-35 changes without checking for updates manually.
Monitor payer policy activity
Governs how AlohaCare and its delegates handle prior authorization requests with insufficient documentation, including outreach attempts, use of fax/phone, and adherence to state regulations; applies to Medicaid and Medicare lines of business and provider interactions for pharmacy and physician-administered drugs.
No material clinical or coverage changes in this revision.
Provider Outreach & LOI Procedures
Send LOI when PA lacks sufficient documentation
When a provider submits a prior authorization request without sufficient documentation for clinical staff to make a decision, AlohaCare (and its delegates) will send a Lack of Information (LOI) request to the provider and follow all applicable state regulations for timeframes, TAT extensions, and method of request.
- Provider must respond with requested documentation within the timeframe specified under applicable state regulations.
Standard LOI attempt counts and timing (with exceptions)
AlohaCare and its delegates will generally make two (2) LOI attempts. Exceptions: if only 24 hours remain for a physician‑administered drug authorization, only one (1) LOI attempt will be made; for Medicaid pharmacy authorizations with less than four (4) hours remaining, only one (1) LOI attempt will be made.
Minimum LOI outreach methods and denial notice
AlohaCare and its delegates will perform a minimum of one (1) phone call and one (1) fax attempt for LOI outreach (standard practice does not include LOI letters). If a request is denied for Lack of Information, the denial letter will state that LOI was the reason.
- Outreach sequence: one provider outreach call, then send LOI fax requesting additional information.
- LOI letters are not sent as standard practice (fax and phone only).
Use standard fax templates for LOI and related scenarios
AlohaCare and its delegates will use standardized fax templates for LOI-related communications and other scenarios, including Peer‑to‑Peer, Grace Period, Cancelled Notification, and Lack of Information; providers should expect LOI requests via these standard fax templates.
Key Terms
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.