Check out the service code in opposition to the YCCO PA record to determine issues for publishing the code. In the event the code would not exist within the PA list, it doesn't imply that a PA is just not demanded.

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Preauthorization Denials – Reconsideration has to be been given inside of sixty days through the day from the denial and we is not going to settle for added information it is a evaluate of the information submitted from the authorization ask for. If there is new clinical data you should submit a whole new prior authorization ask for.

Prior Authorization: No reconsideration is approved for claims denied for no prior authorization you should use the retrospective critique procedure.

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Subsequent requests for same diagnostic company (not in a very sequence) and same diagnosis will require a PA to get submitted with YCCO

Information about what services require preauthorization is situated in CIM. Transplant solutions demand a Particular PA Type below is the link to this manner.

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Companies really should encourage customers to employ the member enchantment procedure for this kind of denial. YCCO will only critique the prior authorization details submitted in the original request NO NEW medical information and facts are going to be reviewed. When you've got extra medical data it's essential to post a fresh prior authorization.

If due to a system difficulty (submitted electronically and There's documentation on the submission) Get hold of the Statements Office. No reconsideration is needed.

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This info has actually been updated to clarify the information the Provider Reconsideration Kind has long been updated at the same time be sure to go through to make sure you have one of the most up to date details and form.

Should you be a THW provider and have an interest in becoming a member of our provider community remember to email us at [email protected].