Please submit a Retrospective Review Request Form when good cause can be shown why pre-service authorization did not occur prior to services being rendered and/or lack of notification or timely notification for an emergent inpatient admission. It may be possible to get resolution without going through a formal appeal process and minimize administrative burden for your claim submission.
Complete and follow the instructions in the Retrospective Review Form below. If it is determined the request is eligible for review, a decision will be made within 30 calendar days following receipt of your request.
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