Effective 10/1/17 Expedited Service Authorization Requests will now be processed within 72 hours from the date of receipt.
Our authorization request type definitions are as follows:
EXPEDITED SERVICE AUTHORIZATION REQUEST
A request for services in which either the requesting provider indicates or the Contractor determines that following the standard timeframes for issuing an authorization decision could seriously jeopardize the member's life or health or ability to attain, maintain, or regain maximum function. In these circumstances, the authorization decision must be expedited and must be made within 72 hours from the date of receipt of the service request. If the due date for an expedited authorization decision falls on a weekend (Saturday and Sunday) or legal holiday as defined by the State of Arizona, the expedited decision must be made
on the day preceding the weekend or holiday.
EXPEDITED AUTHORIZATION REQUEST DOWNGRADED TO A STANDARD REQUEST
When a Mercy Care Plan or Mercy Maricopa Integrated Care receives an expedited request for a service authorization and the requested service is not of an expedited medical nature, the Contractor may downgrade the expedited authorization request to a standard request.
STANDARD SERVICE AUTHORIZATION REQUEST
A request from the member, the representative, or a provider for a service for the member. The authorization decision must be made within 14 calendar days from the date of receipt of the service request.
The change that goes into effect 10/1/17 is for expedited requests. The requirement now indicates the decision must be made no later than 72-hours after receipt of an expedited service versus the previous definition of 3 business days. If you have a request that should be processed as an expedited service authorization request, please call the prior authorization department. This new change has also been made to our provider manuals.
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