News
After Hour Notification
Date: 11/20/2015
We appreciate your participation in the Cenpatico Network and the efforts you make to ensure Buckeye Health Plan®, Inc. members are receiving high quality and effective care. We are pleased to inform you about enhancements we are making to our after-hours utilization review procedures.
Cenpatico will be implementing additional staff availability to include review after business hours. This shall include being available on weekday evenings, as well as Saturday and Sunday to conduct utilization review for new admissions to your facility beginning April 24, 2015. We will have clinical staff available to review medical necessity and issue a determination. If you have an admission that occurs after normal business hours, you will need to continue to utilize our toll-free number to notify us of an admission that occurs; however, authorization and payment will require clinical review. Our after-hours clinicians will conduct outreach to obtain clinical information and apply Medical Necessity Criteria. A decision on authorization will be made within 24 hours of the receipt of clinical information. If you do not have any staff available for clinical review on the weekend, the review shall be completed on the next business day, as usual, and Medical Necessity shall be applied back to the date of admission. Waiting until the next business day does not guarantee authorization, so we recommend having staff available on the weekend and evenings to provide clinical information to our team.
We appreciate your partnership as we strive to ensure the best care is provided for Buckeye Health Plan’s members. If you would like to discuss further, please do not hesitate to reach out to your local provider relations representative.
Sincerely,
William Holmes, MD
Senior Medical Director