راهنمای ارائه دهنده

درخواست برای مجوزها/مجوزهای رترو

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).

If, for هر دلیلی، ارائه دهنده لازم می بیند که برای سرویس(ها) مجوز مجدد درخواست کند، این درخواست باید حداکثر تا تاریخ کتبی دریافت شود. چهل و پنج (45) روز تقویمی از تاریخ ارائه خدمات درخواست مجوز مجدد باید فکس شود (855-439-2444) to the attention of the Clinical Department or mailed to the attention of:

Carelon
بخش بالینی
صندوق پستی 1840
Cranberry Twp., PA 16066-1840

The request for a retro-authorization only guarantees توجه 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 چهل و پنج (45) روز تقویمی از تاریخ ارائه خدمات ترتیب اثر داده نخواهد شد.

پرداخت برای مجوزهای قبلی

اگر ارائه دهنده دریافت کرد تایید کتبی 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 تعدیل ادعاها, outlined in Section VI of Claims Payment. The claim must be received by Carelon within نود (90) روز تقویمی from the date on the approval letter.

Below is the link to the Retro-Authorization form that needs to be completed and sent to the Clinical Department.

فرم مجوز یکپارچهسازی با سیستمعامل - فقط پنسیلوانیا مدیکید