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 the Harvard Pilgrim and Tufts Health Plan provider portals, or by fax.
Visit the Harvard Pilgrim and Tufts Health Plan websites to access more information and resources including fax numbers and prior authorization request forms.
Extending the response timeframe for inpatient concurrent reviews
The timeframe for providers to respond back to requests for additional information on inpatient concurrent reviews varies by product line. To ensure consistency and allow more time for providers to respond, the required response time will be extended to 48 hours for all lines of business. Over the next several weeks, we will update our systems and notifications to reflect this change.
Audrey Kleinberg,
Director, Provider Relations & Communications
Annmarie Dadoly,
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Stephen Wong,
Writers
Kristin Edmonston,
Production Coordinator
Kristina Cicelova,
Graphic Designer