24-Hour Response Time for Urgent Authorization Requests: Effective January 3, 2011
Beginning January 3, 2011, if you are making an URGENT authorization request on a WEEKEND or HOLIDAY, for a service or services requiring prior authorization, please fax or phone the request to the following.
As part of the implementation of the Health Care Reform guidelines, Blue Cross and Blue Shield of North Carolina (BCBSNC) will respond to all urgent authorization requests within 24-hours of receipt of the authorization request and supporting clinical documentation - including on weekends and holidays.
Providers should only be submitting urgent authorization requests on cases that meet the criteria of urgent as outlined below. Because of the new guidelines it is important to remove the word "urgent" from all fax coversheets and documentation, unless the case is truly considered urgent; this will prevent a delay in the review process.
For Federal Program Employees, please refer to the provider manual for instructions regarding submission of requests for services that require prior authorization.
As part of the new Health Care Reform Guidelines urgent requests are defined as requests for medical care or treatment with respect to which the application of the time periods for making non-urgent care determinations could seriously jeopardize the life or health of the member or the ability of the member to regain maximum function; or, in the opinion of a physician with knowledge of the member's medical condition, would subject the member to severe pain that cannot be adequately managed without the care or treatment that is the subject of the request.