Extended Prior Authorization Timelines Ending

  • June 4, 2020

    What happened?

    To better serve our members and providers on February 1, Premera made some process changes in response to the COVID-19 outbreak.

    What’s next?

    On June 1, 2020, we will resume the following:

    • Prior authorization for services with location of hospital inpatient (IP) or hospital outpatient (OP) (outpatient hospital location codes 19 and 22)
    • Inpatient admission review for acute care facilities
    • Inpatient concurrent review for acute care facilities
    • Retrospective review for all inpatient hospital, outpatient hospital, and emergency services
    • Post-acute placement prior authorization for skilled nursing facility, home health, acute rehab, and long-term acute care
    • Revert prior authorization for services to 90 days
    • Contract exclusions and experimental and investigational services on the Clinical Review Coding (CRC) list – standard review process will apply

    Some self-funded employer groups did not opt into this process, so you’ll need to check benefits for your patient before providing care.


    Call us Monday – Friday, 8 a.m. to 5 p.m. PST at 877-342-5258, option 4. We are here to help!

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