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PAP240

Request for Medical Necessity on Elective Procedure


Provider Administrative Policy

Section
Claims Submission
Policy Date
February 2009
Status/Date
October 2009
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Request for Medical Necessity on Elective Procedure

The Medical Management department receives a large number of requests for prior authorization on elective procedures performed within a few days of the request. Elective procedures do not qualify as emergency or urgent situations; therefore, request prior authorization for elective procedures at least 10 working days prior to the procedure. If you believe a specific procedure qualifies as an emergency or urgent situation, please address that when requesting a prior authorization.  See PAP100 for contact numbers.


Policy History

Date Action Reason
October 2009 Revised Added link to PAP100 and removed phone numbers
May 2008 Revised Language clarification

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