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What are the timelines for UM/QIO providing a response to a request?

For pre-certification and concurrent requests, UM/QIO will complete the review within two business days of receipt of all necessary information. For example, if a pre-certification/concurrent request is received on Monday, the provider will have a response by close of business Wednesday (day two).

For retrospective requests, UM/QIO will complete the review within 20 business days of receipt of all necessary information. For example, if a retrospective request is received on April 3, 2009, the provider will have a response by close of business May 1, 2009.

If a pre-certification request is pended for additional administrative information (intake level) or additional information (first level review), the provider has three business days to submit the information. The receipt date of the request is updated when the information is received.

If a concurrent request is pended for additional administrative information (intake level), the provider has three business days to submit the information. If a concurrent request is pended for additional information (first level review), the provider has one business day to submit the information. The receipt date of the request is updated when the information is received.

If a pre-certification/concurrent request is pended by the physician review team, the provider has one business day to submit the information. The receipt date of the request is updated when the information is received.

If a retrospective request is pended for additional information (first level review), the provider has ten business days to submit the information. The receipt date of the request is updated when the information is received.

If a review is pended at multiple levels, such as intake, (nurse first level review), physician, the time frame is extended accordingly.