HealthHelp advanced imaging prior authorization request reminder

Don’t forget about HealthHelp's enhanced case initiation requirements now in effect for prior authorization requests. These lead to a more efficient review process while maintaining compliance with industry and regulatory expectations.

To support timely utilization management determinations, be sure to submit the necessary clinical information at the time you initiate a request. For WebConsult submissions, you may either complete the required clinical questions or upload supporting documentation containing the minimum clinical information needed for review. For requests submitted by phone, HealthHelp intake staff will collect the required clinical information during the call.

Providing complete clinical information upfront avoids unnecessary delays, due to less need for follow-up outreach. Then more requests can be reviewed and processed without pended status.

The requirement also aids compliance with regulatory and accreditation standards, including expectations related to appropriate documentation, utilization management processes and collecting only the information needed to support a coverage determination.

Tips for successful requests:

• Submit the required clinical information when initiating an authorization request.
• For WebConsult requests, completing the clinical questions remains the preferred and most efficient option.
• Uploading supporting documentation is acceptable if it contains the necessary clinical details for review.
• Complete submissions minimize administrative back-and-forth and expedite determinations.

HealthHelp’s existing outreach protocols haven’t changed. If more information is needed to make a determination, HealthHelp will continue to follow its established provider outreach procedures.