Prior authorization and concurrent review decision timeframes
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This document governs the timelines Elderplan/HomeFirst uses to decide prior authorization and concurrent service-authorization requests and affects members and providers submitting those requests.
Decision timeframes for prior authorization and concurrent review requests have been updated and take effect April 1, 2026.
Authorization Decision Timeframes
Authorization decision timeframes
Decision timeframe criteria for different request types:
Provider Timelines and Required Actions
Prior authorization standard timeframe
Standard prior authorization requests will receive a decision within 3 business days from receipt of all required information, but no later than 7 business days from receipt; Elderplan/HomeFirst will notify the requester if additional information is required before day 7.
- Decision within 3 business days from receipt of all required information
- Maximum timeframe: 7 business days from receipt
- Notice provided if additional information is required before day 7
Concurrent review timeframe
Concurrent (current service) assessment requests will receive a decision within 1 business day from receipt of all required information, but no later than 7 business days from receipt; Elderplan/HomeFirst will notify the requester if additional information is required before day 7.
- Decision within 1 business day from receipt of all required information
- Maximum timeframe: 7 business days from receipt
- Notice provided if additional information is required before day 7
Post-hospital rehabilitation expedited timeframe
Requests for post-hospital inpatient rehabilitation are expedited: decision within 1 business day from receipt of all required information, but no later than 7 business days from receipt; Elderplan/HomeFirst will notify the requester if additional information is required before day 7.
- Expedited decision within 1 business day from receipt of all required information
- Maximum timeframe: 7 business days from receipt
- Notice provided if additional information is required before day 7
Key Term Definitions
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.