165.984               Prior Authorization for Procedures Under Managed Care: Limits on Time Requirements

165.984               Prior Authorization for Procedures Under Managed Care: Limits on Time Requirements:

MSSNY supports the requirement that managed care organizations implement and comply with written procedures to assure that entities that conduct utilization review: (1) provide adequate access to its review staff by a toll-free or collect call phone line, at a minimum, from 8:00 a.m. of each standard business day; (2) establishment of written procedures for receiving or redirecting after-hour calls either in person or by recording; and (3) having a mechanism to receive timely call backs from providers. (HOD 1996-76; Reaffirmed HOD 2014; Reaffirmed HOD 2024)