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Prior Authorization Tips - Timeliness of Prior Authorization Requests

Date: 04/06/18

In order to efficiently process prior authorization (PA) requests, Magnolia requests that providers submit PA requests prior to services being rendered. For all pre-scheduled services including scheduled and elective admissions (excluding maternity deliveries) requiring prior authorization (PA), providers should notify the Plan 14 calendar days but no later than five (5) calendar days prior to the requested service date by contacting the Prior Authorization Department via phone, fax, mail, secure email or secure webportal. PA is not requiredfor emergent or urgent care services. Post-stabilization services do not require authorization. Once the member’s emergency medical condition is stabilized, certification for hospital admission or authorization for follow-up care is required. Facilities are required to notify the Plan of all inpatient admissions within one (1) business day following the admission. Facilities are required to submit a request for authorization within two (2) business days following the date of inpatient admissions that are not planned or elective, and sufficient clinical information must be submitted to support medical necessity.