When submitting wheelchair authorization requests for our members, our utilization management team asks that you now request only the duration you anticipate the member will need based on their condition – and include the member’s clinical evaluation / documentation with your request.
Submitting this way, rather than requesting the full allowed amount for the capped rental in all cases, will:
- Streamline medical necessity reviews
- Ensure authorizations better align with our members’ clinical needs
- Reduce partial denials
When you submit a wheelchair authorization request for the full capped rental allowed duration, we’ll review as follows:
- If the order is for a shorter duration or the member has an acute injury with expected recovery in a few months, we issue partial approvals for three months.
- If the wheelchair is still needed beyond that, we ask that providers submit a new authorization with updated clinical documentation.