Utilization Management requests are initiated by providers by either phone or faxing the request for prior authorization form to the intake department.
- Intake phone number: 877-560-8055
- Intake fax number: 855-653-8129
- Intake fax number for concurrent review (inpatient requests): 855-653-8129
Concurrent stay Requests are initiated when a member is currently in the hospital bed and reviewed within 24 hours.
Prior authorization requests are initiated before outpatient services have been provided and are reviewed as follows:
- Routine request: within three business days
- Urgent request*: within 72 hours
Please have the following information available when calling the intake department at 877-560-8055:
- Member name and identification number
- Diagnosis code(s)
- Procedure code(s)
- Date of service
- Primary care physician, specialist and facility names
- Clinical justification for request
- Treatment and discharge plans (if known)
* Urgent Prior Authorization is defined as a condition that a delay in service could result in harm to a member.