8/18/2025

STAFF NOTICE: 

Confirm Urgency Before Submitting Authorization Requests
Dear Office Staff,
This is a reminder that urgent authorization requests must meet specific clinical urgency criteria. Urgent requests should only be submitted when using the standard review timeframe would seriously jeopardize the patient's life, health, or ability to regain maximum function.

Before marking any request as urgent, please confirm: 

     -  Is there clinical documentation supporting the urgency? 
     -  Is the service medically necessary within 72 hours due to a significant
         health risk?
     -  Is this a last-minute scheduling issue or delayed submission?

             (If so, these do not qualify as urgent.)

Why this matters:

Mislabeling routine requests as urgent can delay care for patients with true urgent needs and may lead to processing delays or denials.
Thank you for your continued partnership in delivering timely and appropriate care to our members.

8/18/2025

UM Turnaround Time Guidelines 

NON-MEDICATION REQUESTS

 Routine:
 Commercial Members: Up to 5 business days
 Medicare Advantage (Senior) Members: Up to 14 calendar days
                                * Effective 1/1/2026: Up to 7 calendar days

 
Urgent:

 All lines of business: Within 72 hours

MEDICATION REQUESTS

Routine: Within 72 hours (all lines of business)
Urgent: Within 24 hours (all lines of business)

8/18/2025

URGENT REFERRAL ATTESTATION NOTICE
Please read before submitting an urgent referral

If you are submitting a referral as urgent, you will be required to attest that:
The ordering provider has requested the referral to be submitted as urgent, and the request meets the definition of an urgent referral, meaning there is a serious and immediate threat to the patient's health if care is delayed.

By attesting, you acknowledge that:

     -  You are submitting on behalf of the ordering provider who has
        determined the referral to be urgent.
    -  Patterns of urgent submissions may prompt review and follow-up
        with your practice management team.

        If the referral does not meet urgent criteria, please correct the
        priority status to "Routine" before submitting.