Timeframes for service authorization requests
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This document sets expected turnaround timeframes for prior authorization and concurrent review requests and describes who to contact for member care; it applies to Vns Health administrative processes for authorization requests.
Required Timeframes & Contact for Authorization Requests
Timeframes for authorization decisions
Standard prior authorization review decisions are targeted to be made within 3 days after receipt when all required information is available, with a maximum of 7 days; if additional information is needed, the decision deadline may be extended up to the 7th calendar day. Concurrent review decisions are targeted within 1 business day when all required information is available, with a maximum of 7 days after receipt.
- Target for standard review decisions: within 3 days when all information is received.
- Maximum decision timeframe for any review: no more than 7 days after receipt.
- Concurrent review target: 1 business day when all required information is available.
Inpatient rehabilitation reauthorization timeframe
For requests related to inpatient rehabilitation (rehabilitation/reauthorization after inpatient admission), the decision is targeted within 1 business day when all required information is available, with a maximum of 7 days after receipt.
- Applies to requests for inpatient rehabilitation services after inpatient admission.
- Target decision timeframe: 1 business day when all information is received.
- Maximum decision timeframe: up to 7 days after receipt.
Member care contact
Provider and member inquiries may be directed to Vns Health Member Care at 1-888-867-6555 (TTY: 711); Member Care is available Monday through Friday from 9:00 a.m. to 5:00 p.m.
- Phone: 1-888-867-6555
- TTY: 711
- Hours: Monday–Friday, 9:00 a.m. to 5:00 p.m.
Timeframe Framework and Processing 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.