When submitting a request for services, we encourage you to pause before checking the box marked urgent. This is because it may impose an unexpected risk or denial for the requested service.
CMS defines expedited/urgent as a request in which waiting for a decision under the standard time frame could place the member’s life, health, or ability to regain maximum function in serious jeopardy. An expedited or urgent request is not intended to be used for any other reason.
An urgent or expedited request requires a much quicker turn around time than a standard request. For example, if you send in a request for an urgent surgical procedure that is scheduled two weeks out from the request date, and the documentation you sent along with the request is missing some vital information, you may not have enough time to provide the additional required documentation. We would need that information within 24 hours to render a decision. This request may likely be denied for missing documentation. Whereas, if the same request was marked as standard, then you would have additional time (3- 14 calendar days, depending on the line of business) to provide the needed information. If the information is received, then the request would likely be approved.
We are here to support you. Please reach out to the Utilization Management team at any time to discuss a prior authorization request or schedule a peer-to-peer at umfax@versanthealth.com