Appointments for referrals and urgent prior authorization requests

For routine authorization requests, please schedule appointments with a consulting specialist at least 7 to 10 days after submitting your prior authorization request, to allow time for processing.

For urgent/expedited requests, identify the request as "Urgent" when sending it to Review Services. Urgent requests typically require a conversation between the referring and the referred-to providers. In addition, you must send the supporting clinical information along with your request and the referring provider must be available for consult with the Kaiser Permanente physician reviewer. If the referring provider is not available, provide contact information for someone who will be available for a consult or questions about the request.

Requests identified as "Urgent/Expedited" must meet the following definition:

Urgent care review request means any request for approval of care or treatment where the passage of time could seriously jeopardize the life or health of the patient, seriously jeopardize the patient's ability to regain maximum function, or, in the opinion of a physician with knowledge of the patient's medical condition, would subject the patient to severe pain that cannot be adequately managed without the care or treatment that is the subject of the request.

Requests that are identified as "Urgent" that do not meet this definition cause unnecessary and possibly harmful delays in responding to other urgent requests.

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