What You Need to Know

This page includes information required under federal regulation 42 CFR 422.122(c). This rule helps ensure Medicare Advantage members can see how well their health plan provides access to care through the prior authorization process.

A prior authorization is when your provider asks the plan to approve a service, treatment, or medication before it is provided. This helps confirm the service is medically necessary and covered.

Medicare Advantage plans must follow required timeframes when making these decisions:

• Standard (routine) requests are used when your condition is not urgent. Decisions are made as quickly as your health requires, but no later than 14 calendar days after the request is received.
• Expedited (fast or “STAT”) requests are used when waiting could seriously harm your health or ability to function. Decisions must be made within 72 hours.

In some cases, timeframes may be extended if additional information is needed and the delay is in your best interest.

We track and share this information so you can see how well we are meeting these requirements. Our goal is to make sure you get timely, appropriate care and that decisions are made as quickly as possible.