Руководство поставщика

ЗАПРОСЫ РАЗРЕШЕНИЙ / РЕТРО-РАЗРЕШЕНИЯ

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).

Если для какой-либо причине, 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 сорок пять (45) календарных дней 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 Health of Pennsylvania
Клиническое отделение
А / я 1840
Клюква Twp., PA 16066-1840

Запрос на ретроавторизацию гарантирует только рассмотрение 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 сорок пять (45) календарных дней со дня обслуживания не принимается.

Оплата ретро-авторизаций

Если провайдер получил письменное одобрение 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 корректировки требований, outlined in Section VI of Claims Payment. The claim must be received by Carelon within девяносто (90) календарных дней с даты, указанной в письме-одобрении.

Ниже приведена ссылка на форму ретро-авторизации, которую необходимо заполнить и отправить в клиническое отделение.

Форма ретро-разрешения — только для пенсильванской программы Medicaid