Knowing when to mark a Prior Authorization (PA) request as urgent can help create a better experience for all. We often receive requests marked as urgent when the clinical situation does not meet the definition of urgent.
- For PA requests that involve medications, standard requests must be completed within 72 hours for Quartz Medicare Advantage members. (Most commercial members have the same requirement.)
- Sending a PA request as “urgent” signifies that applying the 72-hour standard review timeframe may seriously jeopardize the life or health of the enrollee or the enrollee’s ability to regain maximum function.
When we need to reach out for more information, an urgent 24-hour turnaround does not allow time for providers to get back to us in the time necessary for us to make the decision and get letters in the mail. This can result in unnecessary denials and appeals.
Following the standard 72-hour timeframe provides time to investigate and request additional information.
To help the review process, please also provide clinical information when the request is submitted, whether it’s electronically (via ePA), fax, or Health Link.