Preauthorizations
24 hours
What is TAT for pharmacy decisions and notifications?
Urgent Concurrent Timeline
What is 72 hours from receipt of request?
The name of the template used in Guiding Care to document a retail pharmacy drug request
What is Pharmacy PBM?
Pre-Service Nonurgent timeline to make a decision
What is 14 calendar days to make a decision from receipt of request?
Communication between a practitioner and a MFC DC Medical Director to provide additional information for a pended or denied inpatient day
What is a Peer-to-Peer?
The name of the accordion in Guiding Care where a request for Additional Clinical Information is documented
What is the Additional Details accordion?
Could seriously jeopardize the life, health or safety of Enrollee
What is Urgent (Expedited) Reques?
A reviewe of additional material when a concurrent denial is issued for for insufficient or missing clinical information with an option to reverse the decision
What is a Redetermination?
The name of the application where you can see if an enrollee has primary insurance
What is HRP?
Timeline for decision and notification for Post-Service Requests
What is within 14 calendar days of receipt of request for a decision. Notification within 24 hours from date of decision, not to exceed 14 calendar days?
If you receive clinical for an inpatient stay and the member has been admitted and discharged what type of Auth Priority is this
What is Post-Service/Retrospective review?
Where is subrogation documented on an auth in Guiding Care
What is the Financial Details accordion in the Third Party Liability field?
Decision and Notification for Pre-service Urgent Concurrent and Preservice Urgent
What is decision made no later than 72 hours from receipt of request and notification within 24 hours of decision, not to exceed 72 hours from receipt of request?
How many calendar days does an extension allow for
What is 14 calendar days?
The formulary, forms, polices and resources can be here
What is the MFC website?