Pre-claim level I appeal deadline is now 60 days

As of Mar. 1, 2023, providers now have 60 days post authorization denial to file a level I appeal. If that appeal is denied, they’ll have 30 days post level I appeal denial to submit a level II appeal.

These timelines apply to both medical and behavioral health appeals for the following lines of business:

  • Commercial
  • Individual
  • Medicaid
  • Medicare post-service pre-claim for in-network providers 

How to increase authorization approvals

Be sure to submit clinical documentation with every authorization request to support medical necessity. Many authorization denials are due to lack of sufficient documentation submitted with the initial request.

Our GuidingCare guides are a great resource and include a list of documents to consider including with your requests. To get them:

  1. Log into your prism account.
  2. Click Request an auth under the Authorizations menu.
  3. Click Auth request help page.