Manuale del fornitore

RICHIESTE DI AUTORIZZAZIONI / RETRO-AUTORIZZAZIONI

Upon receipt of a request for authorization for services, by phone, electronic, or fax transmittal, Carelon has ten (10) business days to enter a provider’s authorization. Providers should be able to access authorizations within 2 business days of a decision. An icon will appear on the ProviderConnect home page indicating that new authorization letters are available. Click on the link on the ProviderConnect home page to go to links to new authorization letters. Print the letters or save them to your computer. Only approval letters are electronic. Adverse determination letters and return of incomplete requests will continue to be sent to providers via US Mail. Providers may also request a fax-back copy of an authorization letter via touch tone telephone. Call 1-866-409-5958 and have available the provider NPI, fax number to receive the fax-back document, member ID number, authorization dates requested, and authorization number (if obtained previously).

Se, per qualche ragione, the provider finds it necessary to request a retro-authorization for behavioral health service(s), the request must be received in writing no later than quarantacinque (45) giorni di calendario from the date of service. The request for behavioral health retro-authorization must be faxed to Carelon Health of Pennsylvania (Behavioral Health) Services (855-439-2444) to the attention of the Clinical Department or mailed to the attention of:

Carelon Salute della Pennsylvania
Reparto Clinico
PO Box 1840
Cranberry Twp., PA 16066-1840

La richiesta di retroautorizzazione garantisce solo considerazione of the request. The provider will receive written notification within thirty (30) calendar days from Carelon’s receipt of the request, approving or denying the service. Any requests for retro-authorization(s) received beyond quarantacinque (45) giorni di calendario dalla data di notifica non sarà data considerazione.

Pagamento per retroautorizzazione

Se il provider ha ricevuto approvazione scritta for the retro-request for service(s) and has not previously submitted a claim, the provider should follow the procedures as outlined in the Carelon Provider Manual for submission of adeguamenti dei sinistri, outlined in Section VI of Claims Payment. The claim must be received by Carelon within novanta (90) giorni di calendario dalla data sulla lettera di approvazione.

Di seguito è riportato il collegamento al modulo di retroautorizzazione che deve essere completato e inviato al reparto clinico.

Modulo di autorizzazione retrò - Solo Pennsylvania Medicaid