Preauthorization

(1) Preauthorization shall be required for all non-emergency hospitalizations, non-emergency transfers between facilities, and non-emergency surgery. Decisions regarding authorization shall be communicated to the requesting provider within seven (7) business days of the request being received. Failure to provide a timely decision within seven (7) business days shall result in the authorization being deemed approved. (2) If a provider makes a written request by fax or e-mail (and receives acknowledgement of receipt of the request) for authorization for a treatment at least twenty-one (21) business days in advance of the anticipated date that treatment is to be delivered and has not been notified of a denial or modification in writing or confirmed telephone call or confirmed fax at least seven (7) business days in advance of the date of the proposed treatment, it is presumed to be medically necessary, a covered service, and to be paid for by the employer. (3) If a provider makes a verbal request for authorization, the burden of proof for showing that authorization was granted by the employer rests with the provider. RULES FOR MEDICAL PAYMENTS CHAPTER 0800-02-17