Utilization Management
REFERRAL | MAKES DECISION | FAX/PHONE NOTIFICATION | WRITTEN NOTIFICATION (DENIALS) |
|---|---|---|---|
Non-Urgent pre-service review | Within 14 days of receipt of the request. | Within 14 days of receipt of the request | Within 14 days of receipt of the request. |
Urgent pre-service review | Within 72 hours of receipt of the request. | Within 72 hours of the request. | Within 72 hours of the request. |
Urgent Concurrent | Within 24 hours of receipt of the request. 48 hours if clinical is not included. | Within 24 hours of receipt of the request. 48 hours if clinical not included. | Within 72 hours of the decision. |