プロバイダーマニュアル

承認/レトロ承認のリクエスト

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).

の場合、 何らかの理由, 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 45暦日 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:

ペンシルベニア州ケアロン・ヘルス
臨床部
POボックス1840
Cranberry Twp。、PA 16066-1840

遡及承認のリクエストは、保証するだけです 考慮 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 45暦日 サービスの日付から考慮されません。

遡及承認の支払い

プロバイダーが受け取った場合 書面による承認 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 クレーム調整, outlined in Section VI of Claims Payment. The claim must be received by Carelon within 90暦日 承認書の日付から。

以下は、記入して臨床部門に送信する必要がある遡及承認フォームへのリンクです。

遡及認証フォーム – ペンシルベニア メディケイドのみ