Service authorization timeframes
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This document governs prior authorization decision timeframes and related member handbook updates for Elderplan/HomeFirst members, affecting requests for service authorization and concurrent review. It applies to the payer's membership broadly.
No material clinical or coverage changes in this revision.
Authorization decision timeframes
Authorization decision timeframes
Decision timeframes and notification rules for different request types
Provider notice: required timeframes and actions
Standard prior authorization timeframe
For standard prior authorization requests, Elderplan/HomeFirst will make a decision within 3 business days after all required information is received, and no later than 7 days after receipt of the request; if more information is needed, the member/provider will be notified by day 7.
- Decision within 3 business days after all required information is received
- Decision no later than 7 days after receipt of the request
- If additional information is needed, member/provider notified by day 7
Concurrent review timeframe
For concurrent review requests, Elderplan/HomeFirst will make a decision within 1 business day after all required information is received, and no later than 7 days after receipt of the request; if more information is needed, the member/provider will be notified by day 7.
- Decision within 1 business day after all required information is received
- Decision no later than 7 days after receipt of the request
- If additional information is needed, member/provider notified by day 7
Post-hospitalization rehab authorization timeframe
For inpatient-to-rehabilitation (post-hospitalization) authorization requests, Elderplan/HomeFirst will make a decision within 1 business day after all necessary information is received, and no later than 7 days after receipt of the request; if more information is needed, the member/provider will be notified by day 7.
- Decision within 1 business day after all necessary information is received
- Decision no later than 7 days after receipt of the request
- If additional information is needed, member/provider notified by day 7
Effective date and handbook updates
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.