Prospective or concurrent reviews of requests for authorization require a five business day turnaround of the decision. When do the five days begin?
A. Prospective or concurrent decisions must be made within five business days from the date the written request for authorization was received. (8 CCR ยง9792.9 (b)(1)) According to the California Civil Code: “The time in which any act provided by law is to be done is computed by excluding the first day and including the last, unless the last day is a holiday, and then it is also excluded.” In other words, except for expedited reviews (see below), if you receive an authorization request sometime before 5:30 p.m. on a Tuesday (non-holiday), and you need no further information, the clock starts the next day, Wednesday. The reviewer must make the decision no later than the following Tuesday (the 5th day), as long as there are no other “holidays” and communicate the decision by phone or fax within 24 hours of the decision. Saturday and Sunday are not counted as business days, and therefore receipt of requests on a weekend or a holiday does not count as a receipt, until the next business day.
A. Prospective or concurrent decisions must be made within five business days from the date the written request for authorization was first received, whether by the employer, the claims adjuster or the URO. (CCR, Title 8 9792.9 (b)(1).) According to the California Civil Code: “The time in which any act provided by law is to be done is computed by excluding the first day and including the last, unless the last day is a holiday, and then it is also excluded.” In other words, except for expedited reviews (see below), if you receive an authorization request sometime before 5:30 p.m. on a Tuesday (non-holiday) the next day, Wednesday, is counted as day one. The reviewer must make the decision no later than the following Tuesday (the 5th business day). The decision must be communicated by phone or fax within 24 hours of making the decision. Saturday and Sunday are not counted as business days, and therefore receipt of requests on a weekend or a holiday does not count as a receipt, until the
Related Questions
- Prospective or concurrent reviews of requests for authorization require a five business day turnaround of the decision. When do the five days begin?
- What is the expected turnaround time for a decision given a complete prior authorization submission?
- Who reviews and makes the decision on my doctors authorization request?
