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Provider Manual

Utilization Management Timeliness Standards

Last Updated on November 24, 2020
Precertification: Nonurgent Retrospective Expedited
Initial decision-making and notification within 14 calendar days of receipt of request 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 14 calendar days of receipt of request within 30 calendar days of receipt of request no later than 72 hours after receiving request
 Written notification of approval to member and provider if applicable  within 14 calendar days of receipt of request  within 30 calendar days of receipt of request  no later than 72 hours after receiving request
 Verbal notification of denial to member and provider if applicable  within 14 calendar days of receipt of request  No verbal notification  no later than 72 hours after receiving request