Non-Medicare outpatient services moving to 90-day window for retro authorizations

Starting Oct. 14, 2020, we’ll be transitioning non-Medicare outpatient services to a 90-day window for submission of retrospective authorizations. Retrospective authorizations submitted outside the 90-day window will be denied. As a reminder, Medicare does not allow for retrospective authorizations.This change takes place after the launch of our new authorization tool, GuidingCare, which will go-live on Sept. 14, 2020. Learn more about GuidingCare and register for training here.

How we’re preparing for the transition

Prior to Oct. 14, we’ll flag outpatient retro authorizations submitted to GuidingCare outside of the 90-day window. Our utilization management (UM) team will be tracking these flagged submissions and will send you a notification within the GuidingCare tool to let you know your retro authorization request is being reviewed, subject to our current one-year guideline. The message will also remind you that starting Oct. 14, we’ll no longer accept retro-authorization requests submitted after 90 days.