This is only my second post. I have already been in trouble by the way I posted my first one. HOPE THIS WILL BE OK!!!
When the Utilization Review sends back it's determination and answer and it is NOT within the time guidelines set forth in LC, WHAT SHOULD HAPPEN?
Scenario: PTP sends request to see specialist to CA on 10/5/06---CA denies and sends to UR.---UR denies authorization to see specialist as not medically necessary on 12/18/06---Approx. 44 days later.
It is unknown whether or not any extensions were filed.
Does this scenario automatically trigger the PQME process
If in fact, there were no extensions filed, and nothing interfered with the process, would I be permitted to make appt. with specialist based on presumptive approval because of UR's untimeliness?
How can I investigate to see if extension or ???? were filed that could possibly stretch this out to 44 days??
Any opinions will be most welcome. THANKS!!!!