Requesting back-dated authorizations

THESE REQUIREMENTS WERE REMOVED 7/1/2008

How to request that Priority Health back-date authorization for behavioral health services:

1. Contact the Behavioral Health department at 616 464-8500 or 800 673-8043 to complete clinical case review and request backdating with an Outpatient Clinical Case Manager.
2. We will make a decision on your request at the time of your call, or get back to you by telephone within 3 business days to notify you of our decision.

Note: Provider Services staff does not work on these requests unless specifically related to provider contractual issues.

Limitations on back-dated approvals:

• Individual providers are allowed 3 unique member back-dated approvals per calendar year.
• Agencies are allowed 6 unique member back-dated approvals per calendar year.
• New Priority Health participating providers are granted unlimited backdating requests for a 1-year period following being accepted into the provider panel, to assist them in becoming acclimated to the clinical case review process.

Reasons approvals may be granted:

• Provider/facility error
• Trouble accessing the USCR line
• Confusion over insurance (provider liable)

After a provider receives the maximum number of back-dated approvals for these reasons (see Limitations, above), further requests for approvals using these reason codes will not be granted for the remainder of the calendar year. Requests for back-dated approvals for other reasons may still be granted on a case-by-case basis in situations related to member error or Priority Health error.