Oncology Service Date Revisions (Backdating)
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This policy governs how AlohaCare handles revisions (backdating) of oncology prior authorization service dates for covered members, outlining allowable justifications and timeframes for making such revisions. It affects providers requesting service date changes and internal Optum/AlohaCare staff processing them.
No material clinical or coverage changes in this revision.
Service Date Revision Coverage Criteria
Service date revision criteria
Covered when ALL of the following conditions are met:
Timing for request
- Request is made within 30 days after the start of treatment (standard revision window).
- Request is made more than 30 days after the start of treatment AND the member remains under care (may be allowed; not treated as retrospective review).
Acceptable justifications (at least ONE)
- Natural disaster.
- System outage.
- Provider can demonstrate they received misinformation from the system, from MedOnc, or from AlohaCare about whether a prior authorization was required.
Coding and Timing Summary
| No codes listed |
Provider Requests and Operational Rules
Request service date revision (backdating)
Providers may request service date revisions (backdating) of prior authorizations; such requests are approved at AlohaCare's discretion and follow Optum's standard service date revision process.
Observe timing for revision requests
Service date revisions can be made up to 30 days after the start of treatment; revisions beyond 30 days may be allowed only if the member remains under care (requests otherwise are treated as retrospective reviews).
Supply an acceptable justification
Provide one of the accepted justifications when requesting backdating: natural disaster, system outage, or demonstration that the provider received misinformation about whether a prior authorization was required.
- Natural disaster
- System outage
- Provider received misinformation from the system, from MedOnc, or from AlohaCare about PA requirement
Internal notification is not shared with providers
Optum will notify AlohaCare Pharmacy staff when a backdate is needed; that notification is internal and will not be shared with providers.
Definitions and Standard Handling
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