Responding to requests for more information

Prior authorizations are sometimes submitted without all the relevant information needed to conduct a complete review. When this happens, Point32Health will reach out to the provider to obtain the missing information. Because we’re required to make a determination within certain regulatory timeframes using the information that’s available, these requests are often denied if the missing information is not received.  

In many cases, these denials are overturned when the missing information is provided through appeals. However, going through the appeals process when the request could be approved initially is an unnecessary administrative burden for providers and may cause a delay in patient care. To avoid these denials, please respond back timely to requests for more information. Additional information can be submitted through our secure provider portal or by fax at 857-304-6463. 

Extending the response timeframe for inpatient concurrent reviews 

Previously, the timeframe for providers to respond back to requests for additional information on inpatient concurrent reviews was 24 hours. To allow providers more time to respond, the required response time has been extended to 48 hours. Over the next several weeks, we will update our systems and notifications to reflect this change.