Facilities: Acute inpatient authorization denial calls stopping April 8, check GuidingCare

Central to our shared priority of ensuring our members, your patients, get the care they need when they need it are timely and efficient authorization decision notifications.

In support of this goal, we’re updating our notification process for acute inpatient prior authorization denials.

Effective April 8, facilities must look to GuidingCare for most acute inpatient authorization denials as our utilization management team will no longer call. These decisions along with denial letters are already available in the authorization portal’s Authorization List area.

Turnaround times remain the same

This update will not impact decision turnaround times, which for acute inpatient authorization requests are:

• Commercial: 24 hours (up to 72 hours if additional information is needed)
• Medicare / Medicaid: 72 hours

Exceptions

Our teams will occasionally make call notifications for acute inpatient authorization denials after April 8, under the following conditions:

• Transfer requests
• Any situation where timely notification cannot be done electronically
• When additional information is needed for review of medical necessity of the admission, as needed