Finding a submitted preauthorization request is easy. You have two options to get to the search screen:
1. Take action tile.
2. Preauthorization menu.
How To Find Submitted Preauthorizations and Determination Letter
Introduction
Knowing how to find submitted requests will help you:
- Check status.
- Find approval numbers.
- Add additional supporting documentation.
- Find determination letters (UM Letters).*
The following shows you how to find the requests and helpful tips for using the available information. Let’s start with finding the request.
Note: For instructions on finding draft preauthorization requests, see the Create Preauthorization guide.
*Currently available for New York commercial members only.
Getting to the Search Screen
Searching for a Submitted Preauthorization Request
Once on the Search Preauthorizations page you will:
Step 1
You have seven search options:
1. Reference ID (recommended).
2. Member ID.
3. Member Name.
4. Requesting Provider Name.
5. Requesting Provider NPI.
6. Servicing Provider Name.
7. Servicing Provider NPI.
Step 2
Click Search to view a table with requests that match your search criteria.
Click the Reference ID to select the applicable request. You can use Filter By to target the request if too many rows are returned.
Preauthorization Details - Overview
On the Preauthorization Details page you can:
- See the review’s status.
- Expand sections with an “>” to see available details.
- See utilization review letters in the UM Letters section.
- Click Ask a Question to go to the Message Center to ask a question about your preauthorization request.
- Click Add Supporting Documentation to add records or other information needed for a preauthorization request or concurrent review.
- Click the link to find incomplete drafts.
What The Status Means
Status definitions can be found on the bottom of the Preauthorization details page. Here are some detailed explanations:
- Pending Decision - The case is still under review and may be missing information. Consider uploading additional supporting documentation.
- Denied – The request was denied based on the medical review.
- Fully Approved – All requested services are approved.
- Partially Approved – Some requested services are approved while others need further medical review.
- Voided – The request has been canceled.
Add Supporting Documentation
On the Preauthorization Details page, you can:
- See the review’s status.
- Expand sections with an “>” to see available details.
- See utilization review letters in the UM Letters section.
- Click Ask a Question to go to the Message Center to ask a question about your preauthorization request.
- Click Add Supporting Documentation to add records or other information needed for a preauthorization request or concurrent review.
- Click the link to find incomplete drafts.
