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Conclusion of Temporary Suspension on All Medical and Behavioral Health Prior Authorizations

Several months ago, CDPHP® made the decision to ease the administrative burden on practices during the rapidly changing COVID-19 pandemic by lifting all medical and behavioral health prior authorization requirements.

As you may recall, the suspension applied to the following:

  • Suspension of preauthorization requirements for scheduled surgeries or hospital admissions;

  • Suspension of concurrent review for inpatient hospital services;

  • Suspension of retrospective review for inpatient hospital services and emergency services at in-network hospitals and payment of claims;

  • Hospital discharge planning and preauthorization for home health care and inpatient rehabilitation services following an inpatient hospital stay;

  • Hospital discharge planning and concurrent review for inpatient substance abuse disorder treatment and inpatient mental health services;

  • Notification requirements for in-network emergency hospital admissions

In accordance with the New York State Department of Financial Services Circular Letter No. 8, Supplement No. 2, CDPHP will resume the above-mentioned prior authorization requirements effective July 20, 2020.

Prior to submitting a request for pre-service authorization to our utilization review (UR) department, please continue to consult CDPHP policies and procedures, located on the provider portal, for guidance on medical necessity requirements. This also includes services that require care at a Center of Excellence, such as a transplant or out-of-network cancer care.

Should you have questions or need additional support, please contact your provider relations representative.

*Members covered by a self-funded plan should check with their employer’s benefits department for more information.

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