When is it appropriate to expedite a service request?
The expedite option is appropriate when applying standard turnaround times could seriously jeopardize either:
- The life or health of the enrollee OR
- The enrollee’s ability to regain maximum function
If you determine that an expedited service request is appropriate after reviewing the above criteria, please use the “Expedite service” checkbox to mark the request as expedited. After checking the box, you will be presented with a message asking you to confirm the reason why this specific request needs expedited review.
- Ensure your request truly meets this guidance for expediting requests.
- If the clinical documentation does not reflect the urgency of the request, it may be flagged for review and changed to standard.
- Therapy and imaging requests do not typically meet the criteria for expedited processing
If your request meets one of the two options listed on the pop-up, select by checking the box and pressing “Expedite request”. If your request does NOT meet one of the two options listed on the pop-up, select ‘cancel’ to continue submitting your authorization as a standard request.
You will return to the request to see that the expedite service check box is filled. Please continue with the remaining steps to submitting your authorization