Prior authorization determinations for urgent services shall be made within twenty-four (24) hours of receipt of the necessary information, but no later than seventy-two (72) hours after receipt of the request for service.
Written notification shall be provided in accordance with the Notice of Action standards established in the New Jersey state guidelines in Articles 4.6.4 and 5.15 et seq. A. For acute care general, private psychiatric and special hospital inpatient admissions the provider should:
- Conduct medical necessity reviews to confirm acute level of care to approve admission, within 24 hours of hospital’s notification to provider, but not more than 24 hours beyond the time of receipt by the payer from the hospital or physician of the additional information that the payer has identified as needed to approve or deny the request for authorization, as per NJSA 17B :30-52
- Conduct continued stay medical necessity reviews to confirm level of care for approved or denied continued stay authorization within 72 hours of admission.
If you have any questions, please contact your Provider Relations representative. Thank you for your partnership in providing quality care to Fidelis Care members.
