Hướng dẫn sử dụng nhà cung cấp

YÊU CẦU XIN PHÉP / PHÉP THUẾ LẠI

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).

Nếu cho bất cứ lý do gì, 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 bốn mươi lăm (45) ngày theo lịch 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 Y tế của Pennsylvania
Khoa lâm sàng
Hộp thư 1840
Cranberry Twp., PA 16066-1840

Yêu cầu ủy quyền trở lại chỉ đảm bảo Sự xem xét 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 bốn mươi lăm (45) ngày theo lịch kể từ ngày dịch vụ sẽ không được xem xét.

Thanh toán cho Ủy quyền trở lại

Nếu nhà cung cấp nhận được văn bản chấp thuận 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 yêu cầu điều chỉnh, outlined in Section VI of Claims Payment. The claim must be received by Carelon within chín mươi (90) ngày theo lịch kể từ ngày ghi trên thư chấp thuận.

Dưới đây là liên kết đến biểu mẫu Ủy quyền Quay lại cần được hoàn thành và gửi đến Khoa Lâm sàng.

Mẫu Ủy quyền Retro - Chỉ Pennsylvania Medicaid