提供者手册

授权/追溯授权请求

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).

如果，对于 任何原因, 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 四十五 (45) 个日历日 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:

Carelon Health of Pennsylvania
临床科
邮政信箱1840
蔓越莓 Twp., PA 16066-1840

追溯授权请求仅保证 考虑 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 四十五 (45) 个日历日 自服务之日起将不予考虑。

重新授权的付款

如果提供者收到 书面批准 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 索赔调整, outlined in Section VI of Claims Payment. The claim must be received by Carelon within 九十 (90) 个日历日 从批准函上的日期开始。

以下是需要填写并发送到临床部门的追溯授权表的链接。

复古授权表 - 仅限宾夕法尼亚州医疗补助计划