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Provider Manual

Utilization Management Timeliness Standards

Last Updated on October 29, 2018
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 within 3 calendar days of verbal notification