Getting your patients and our members the care they need in a timely manner is our top priority. Here are 7 tips that will result in faster processing of authorization requests and, ultimately, faster approval of appropriate treatment.

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1. Submit Authorization Requests through Availity^®

This is Highmark’s online provider portal and this is the fastest way for authorization requests to be reviewed and approved.

Our Utilization Management data shows that using Availity increases authorization turnaround time by 75% compared to alternative submission channels; some approvals are available immediately.

In addition, Highmark is in the process of phasing out fax and phone for authorization requests. Why wait until the last minute? The sooner you make the switch to Availity, the sooner your practice will see the benefits.

To register for Availity, go here.

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2. Don’t Procrastinate — Timeliness Matters

For each type of Behavioral Health treatment, there are specific timeframes for submitting authorization requests. See below. If you miss those windows, your request will be rejected.

• Initial Clinical: Must be submitted within 7 days of admission.
• Concurrent: Must be submitted on the last coverage date (LCD). Requests submitted 7 days or more after the LCD will not be reviewed.
• Face-to-Face Requirements:
• Psychiatric (Inpatient) and Withdrawal Management: Face-to-face within 24 hours of admission.
• Psychiatric Residential and Residential-Rehab (Substance Use Rehab): Face-to-face within 7 days of admission.

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3. Know Your Codes

Be clear on the level of care requested and submit the correct CPT codes. This will ensure a faster review of your request. The wrong codes will result in unnecessary delay.

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4. Don’t Throw in the Kitchen Sink

Only provide relevant documentation with the request. Don’t send the entire chart; instead, provide a synopsis of the clinical information. Other prohibited attachments include:

• Insurance Verification Notes
• Copies of Member Benefits
• Past Clinical Records
• Call Logs

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5. Always Specify the Level of Care

In Behavioral Health, there are multiple levels of care; each with its own requirements. Be specific. Is it Urgent or Non-Urgent? If it’s Urgent, is it Psychiatric (Inpatient) or Withdrawal Management? The more specific you can be, the faster your request can be reviewed.

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6. Don’t Forget the Basics

It happens. You’re busy... you’re rushing... you’re doing seven other things... and then you hit submit. But you forgot to include something essential, such as:

• Member Information: Name, Date of Birth, Unique Member Identifier (UMI)
• Facility Information: Name and Address
• Level of Care: Specify the level of care requested [e.g., Psychiatric (Inpatient), Psychiatric Residential, Withdrawal Management, Residential-Rehab (Substance Use Rehab)]
• Your Contact Information: Phone and Fax Numbers

Always double-check your authorization request to ensure that all the necessary information is included.

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7. Provide a Synopsis

Summarize the clinical information instead of attaching the entire chart. Tell us the patient’s symptoms and condition and the recommended treatment. This will speed up the authorization review process.

For more tips on submitting BH authorization requests, click here.