Service authorization timelines — decision timeframes for prior authorization and concurrent review requests; Elderplan/HomeFirst
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Defines Elderplan/HomeFirst timeframes for decisions on prior authorization and concurrent review requests for covered services; applies to requests submitted to Elderplan/HomeFirst.
No material clinical or coverage changes in this revision.
Authorization decision timelines
Authorization decision timelines
Decision timeframes for different request types
Codes and key numeric limits
Provider timeframes and action highlights
Standard prior authorization timeframe
Standard prior authorization requests: a decision will be made within 3 business days of receipt of all necessary information, and in no case will the decision period exceed 7 days from receipt of the request; an extension to the 7th day may occur if additional information is needed.
Expedited prior authorization timeframe
Expedited (urgent) prior authorization requests: a decision will be made within 1 calendar day of receipt of all necessary information, and in no case will the decision period exceed 7 days from receipt of the request; an extension to the 7th day may occur if additional information is needed.
Concurrent review and discharge-related timeframe
Concurrent review, rehabilitation, and discharge-related requests: a decision will be made within 1 calendar day of receipt of all necessary information, and in no case will the decision period exceed 7 days from receipt of the request; an extension to the 7th day may occur if additional information is needed.
Timeframe definitions
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