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Retroactive Authorization request: Authorization will be issued when due to eligibility issues. after an appeal is filed. UHC often doesnt receive complete clinical information with an authorization to make a medical necessity determination.
Referrals are effective immediately, but may take up to 2 business days to be viewable in the portal system. They may be backdated up to 5 calendar days before the date of entry.
A referral form is an online form used to request referrals and provides the personal and contact information of both the referral and the referee.
Call the phone number on your member ID card or sign in to your health plan account and review your benefits to learn if prior authorization is needed.
The PCP must generate a referral for the member to receive specialty care. If the PCP is non-responsive, the specialist may have the member contact Member Services for UHCCPNJ to change the assigned PCP by calling the number on the back of their ID card.
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Please refer to the specific coverage information you receive after you enroll. A decision on a request for prior authorization for medical services will typically be made within 72 hours of us receiving the request for urgent cases or 15 days for non-urgent cases.

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