CurrentelderplanPolicy N/A

Service Authorization Timeframes

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Defines Elderplan/HomeFirst timeframes and decision targets for prior authorization and concurrent review requests, including special inpatient rehabilitation requests; applies to Elderplan/HomeFirst members and providers submitting authorization requests.

Policy Summary

Payerelderplan

PolicyService Authorization Timeframes

Policy CodePolicy N/A

Change TypeHandbook update — revised timeframes

Effective DateApr 1, 2026

Last ReviewApr 1, 2026

Next Review DateApr 1, 2026

Key ActionSubmit prior authorization or concurrent review requests to Elderplan/HomeFirst and expect decisions within the specified timeframes.

SourceLink

POLICY UPDATE CHANGES

Member handbook updated to include updated information on service authorization timeframes effective April 1, 2026.

3 work daysprior auth decision target

1 work dayconcurrent review target

1 work dayinpatient rehab target

7 daysmaximum decision window

Authorization Decision Timeframes and Rules

Authorization decision timeframe criteria

Decision timeframes and notification rules for authorization requests

Prior authorization (Standard review): Elderplan/HomeFirst will make a decision within 3 work days of when we have all the information we need, but no later than 7 days after we receive your request.

Notification rule: If more information is needed, Elderplan/HomeFirst will tell the provider/member by the 7th day after receipt of the request.

Concurrent and inpatient rehab criteria

Concurrent and special inpatient rehabilitation timeframes

Concurrent review (Standard review): Elderplan/HomeFirst will make a decision within 1 work day of when we have all the information we need, but no later than 7 days after we receive your request.

Inpatient rehabilitation requests after inpatient hospital admission: Elderplan/HomeFirst will make a decision within 1 work day of when we have all the information we need, but no later than 7 days after we receive your request.

Notification rule: For concurrent review and inpatient rehabilitation requests, Elderplan/HomeFirst will tell the provider/member by the 7th day after receipt of the request if more information is needed.

Coding and Timeframe Summary

Not specifiedmixed

No codes listed

Decision timeframes — Prior auth standard

Prior authorization (standard)Decision within 3 work days of receiving all necessary information; no later than 7 days from receipt; provider/member will be informed by day 7 if more information is needed.

Concurrent review (standard)Decision within 1 work day of receiving all necessary information; no later than 7 days from receipt; provider/member will be informed by day 7 if more information is needed.

Inpatient rehabilitation (post‑hospital admission)Decision within 1 work day of receiving all necessary information; no later than 7 days from receipt; provider/member will be informed by day 7 if more information is needed.

What Providers Must Do

Prior Authorization

Timeframes for authorization decisions

Submit prior authorization or concurrent review requests to Elderplan/HomeFirst. For standard prior authorization reviews, Elderplan/HomeFirst will make a decision within 3 work days after they have all necessary information, but no later than 7 days from receipt; they will notify the provider/member by day 7 if more information is needed. For standard concurrent reviews, Elderplan/HomeFirst will make a decision within 1 work day after they have all necessary information, but no later than 7 days from receipt; they will notify the provider/member by day 7 if more information is needed. For requests for inpatient rehabilitation services after an inpatient hospital admission, Elderplan/HomeFirst will make a decision within 1 work day after they have all necessary information, but no later than 7 days from receipt; they will notify the provider/member by day 7 if more information is needed.

Prior authorization (standard): decision within 3 work days after all information received; no later than 7 days from receipt; notification by day 7 if more information is needed.
Concurrent review (standard): decision within 1 work day after all information received; no later than 7 days from receipt; notification by day 7 if more information is needed.
Inpatient rehabilitation after hospital admission: decision within 1 work day after all information received; no later than 7 days from receipt; notification by day 7 if more information is needed.

Key Definitions

inv-06: Standard review

DefinitionStandard review: a prior authorization determination made for a submitted request under the standard prior authorization process.

Decision targetWe will make a decision within 3 work days of when we have all the information we need, but no later than 7 days after we receive your request.

NotificationWe will tell you by the 7th day if we need more information.

inv-07: Concurrent review

DefinitionConcurrent review: the ongoing review process for services already in progress (e.g., inpatient care), conducted while the member is receiving services.

Decision targetWe will make a decision within 1 work day of when we have all the information we need, but no later than 7 days after we receive your request.

NotificationWe will tell you by the 7th day if we need more information.

inv-08: Inpatient rehabilitation request

DefinitionInpatient rehabilitation request: a request for inpatient rehabilitation services submitted following an inpatient hospital admission.

Decision targetWe will make a decision within 1 work day of when we have all the information we need, but no later than 7 days after we receive your request.

NotificationWe will tell you by the 7th day if we need more information.

Policy Summary

Payerelderplan

PolicyService Authorization Timeframes

Policy CodePolicy N/A

Change TypeHandbook update — revised timeframes

Effective DateApr 1, 2026

Last ReviewApr 1, 2026

Next Review DateApr 1, 2026

Key ActionSubmit prior authorization or concurrent review requests to Elderplan/HomeFirst and expect decisions within the specified timeframes.

SourceLink

On This Page

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Service Authorization Timeframes

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Sign up for all elderplan policy alerts

Know when elderplan releases new policies or updates existing guidance.

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Authorization Decision Timeframes and Rules

Authorization decision timeframe criteria

Decision timeframes and notification rules for authorization requests

Prior authorization (Standard review): Elderplan/HomeFirst will make a decision within 3 work days of when we have all the information we need, but no later than 7 days after we receive your request.

Notification rule: If more information is needed, Elderplan/HomeFirst will tell the provider/member by the 7th day after receipt of the request.

Concurrent and inpatient rehab criteria

Concurrent and special inpatient rehabilitation timeframes

Concurrent review (Standard review): Elderplan/HomeFirst will make a decision within 1 work day of when we have all the information we need, but no later than 7 days after we receive your request.

Coding and Timeframe Summary

Not specifiedmixed

No codes listed

Decision timeframes — Prior auth standard

What Providers Must Do

Prior Authorization

Timeframes for authorization decisions

Prior authorization (standard): decision within 3 work days after all information received; no later than 7 days from receipt; notification by day 7 if more information is needed.
Concurrent review (standard): decision within 1 work day after all information received; no later than 7 days from receipt; notification by day 7 if more information is needed.
Inpatient rehabilitation after hospital admission: decision within 1 work day after all information received; no later than 7 days from receipt; notification by day 7 if more information is needed.

Key Definitions

inv-06: Standard review

DefinitionStandard review: a prior authorization determination made for a submitted request under the standard prior authorization process.

Decision targetWe will make a decision within 3 work days of when we have all the information we need, but no later than 7 days after we receive your request.

NotificationWe will tell you by the 7th day if we need more information.

inv-07: Concurrent review

DefinitionConcurrent review: the ongoing review process for services already in progress (e.g., inpatient care), conducted while the member is receiving services.

Decision targetWe will make a decision within 1 work day of when we have all the information we need, but no later than 7 days after we receive your request.

NotificationWe will tell you by the 7th day if we need more information.

inv-08: Inpatient rehabilitation request

DefinitionInpatient rehabilitation request: a request for inpatient rehabilitation services submitted following an inpatient hospital admission.

Decision targetWe will make a decision within 1 work day of when we have all the information we need, but no later than 7 days after we receive your request.

NotificationWe will tell you by the 7th day if we need more information.