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, Beacon 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 任何原因，提供者认为有必要请求对服务进行追溯授权，必须在不迟于以下时间以书面形式收到请求 四十五 (45) 个日历日 自服务之日起。追溯授权请求必须通过传真（855-439-2444) to the attention of the Clinical Department or mailed to the attention of: Beacon Health Options Clinical Department P.O. Box 1840 Cranberry Twp., PA 16066-1840 The request for a retro-authorization only guarantees 考虑 的请求。提供商将在 Beacon 收到请求、批准或拒绝服务的三十 (30) 个日历日内收到书面通知。收到的任何追溯授权请求超出 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 对于服务的追溯请求且之前未提交过索赔，提供者应遵循 Beacon 提供者手册中概述的程序提交 索赔调整，在索赔付款的第 VI 节中概述。 Beacon 必须在以下时间内收到索赔 九十 (90) 个日历日 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. 复古授权表 - 仅限宾夕法尼亚州医疗补助计划