Timelines for Prior Authorization and Concurrent Review Decisions
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This document governs Vns Health timeframes for reviewing and deciding prior authorization requests and concurrent medical necessity reviews, including certain expedited inpatient rehab requests; it affects providers and members interacting with Vns Health.
Updated decision timeframes for prior authorization and concurrent review requests effective April 1, 2026.
Required Provider Timelines & Contacts
Prior authorization decision timeframes — standard
Standard prior authorization requests must be decided within 3 business days after receipt of all necessary information, and no later than 7 days from receipt of the request. If additional information is required, the plan will notify the requester within 7 days.
- Decision timeframe: 3 business days after receipt of all necessary information
- Maximum timeframe: no later than 7 days from receipt of the request
- Notification to requester if more information is needed: within 7 days
Concurrent review decision timeframes
Concurrent (current) medical necessity reviews must be decided within 1 business day after receipt of all necessary information, and no later than 7 days from receipt of the request. If additional information is required, notification will be provided within 7 days.
- Decision timeframe: 1 business day after receipt of all necessary information
- Maximum timeframe: no later than 7 days from receipt of the request
- Notification to requester if more information is needed: within 7 days
Inpatient rehabilitation post-hospitalization timeframe
Requests for inpatient rehabilitation following hospitalization will be decided within 1 business day after receipt of all necessary information, and no later than 7 days from receipt of the request. If additional information is required, the requester will be notified within 7 days.
- Expedited decision timeframe: 1 business day after receipt of all necessary information
- Maximum timeframe: no later than 7 days from receipt of the request
- Notification to requester if more information is needed: within 7 days
Provider contact — Care Management
For care coordination and prior authorization inquiries, contact the Care Management team at 1-888-867-6555 (TTY: 711), Monday–Friday, 9:00–17:00.
- Phone: 1-888-867-6555
- TTY: 711
- Hours: Monday–Friday, 9:00–17:00
Key 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.