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Provider Manual

Utilization Management

Last Updated on January 24, 2019
Precertification: Nonurgent Concurrent Retrospective Expedited
Initial decision-making and notification within 15 calendar days of receipt of request 24 hours within 30 calendar days of receipt of request no later than 72 hours after receiving request
Written notification of denial to member and provider if applicable within 15 calendar days of receipt of request 1 working day of making decision within 30 calendar days of receipt of request within 3 calendar days of verbal notification