Keystone mercy prior authorization 2025

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
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How long does the prior authorization process take? It typically takes 24 to 72 hours. You may check the status of your prior authorization request on the prior authorizations page. You may also contact your doctors office directly.
Your doctors office is responsible for obtaining prior authorization. They will submit a request to your insurance provider to get approval, whether its for a service or for a medication. Usually, your physician will have a good idea of whether they need to get prior authorization.
Request Expedited Reviews from the Payer for Urgent Cases Healthcare providers must request an expedited review to speed up the prior authorization for urgent medication cases. If a patients condition requires immediate attention, healthcare providers must contact the payer to address the issue.
If you have questions about this tool or a service or to request a prior authorization, call 1-800-521-6622.
At the federal level, earlier this year the Centers for Medicare and Medicaid Services (CMS) issued a final rule that will, among other things, require payers to send prior authorization decisions within 72 hours for urgent requests and within a week for nonurgent requestsstarting in 2026.

People also ask

How long does a prior authorization take? Depending on the complexity of the prior authorization request, the level of manual work involved, and the requirements stipulated by the payer, a prior authorization can take anywhere from one day to a month to process.
Questions regarding enrollment or procedures that require prior authorization should be directed to the SmartHealth Customer Service Department at (888) 492-6811. (Hours of operation are 8:30am-4:30pm EST) Monday-Friday, excluding holidays.

keystone mercy health plan prior auth form