Manwal ng Tagabigay

MGA KAHILINGAN PARA SA PAGKAKATAON / RETRO-AUTHORIZATIONS

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).

Kung, para sa Kahit anong rason, 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 apatnapu't limang (45) araw ng kalendaryo 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
Kagawaran ng Klinikal
PO Box 1840
Cranberry Twp., PA 16066-1840

Ang mga kahilingan para sa isang pagbibigay-pahintulot sa retro ay garantiya lamang pagsasaalang-alang 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 apatnapu't limang (45) araw ng kalendaryo mula sa petsa ng serbisyo ay hindi bibigyan ng pagsasaalang-alang.

Pagbabayad para sa Mga Retro-Pahintulot

Kung natanggap ang provider nakasulat na pag-apruba 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 inaangkin ang mga pagsasaayos, outlined in Section VI of Claims Payment. The claim must be received by Carelon within siyamnapung (90) araw ng kalendaryo mula sa petsa sa sulat ng pag-apruba.

Nasa ibaba ang link sa form ng Retro-Pahintulot na kailangang makumpleto at maipadala sa Kagawaran ng Klinikal.

Retro Authorization Form – Pennsylvania Medicaid Lang