Effective January 1, 2020, the Centers for Medicare & Medicaid Services (CMS) are initiating a change to the precertification timeline for infusion drugs for Medicare Advantage members. This change will significantly shorten the amount of time Medicare Advantage organizations (MAO), such as Independence, are given to make a determination on precertification. MAOs will now only be given hours, rather than days, to notify providers of their determinations.

New time frames

Independence must notify members, as well as the requesting and servicing provider, of its precertification determinations in a timely manner. In accordance with the change CMS is initiating, determinations must be completed as expeditiously as the member’s health condition requires and follow the following time frames:

• Standard determinations must be submitted no later than 72 hours after receipt of the precertification request – a significantly shorter time frame than the 14 days previously allotted.

• Expedited determinations must be submitted no later than 24 hours after receiving the request – a significantly shorter time frame than the 72 hours previously allotted.

We will be working diligently with providers to ensure that precertification determinations are made in a timely manner so that our members and your patients receive the care they need. To do this we need your support and ask that you fax all pertinent supporting clinical information related to your request immediately after submitting an authorization request through the NaviNet^® web portal (NaviNet Open).

Clinical information must be faxed to:

215-238-7956
Attn: Utilization Management

If the supporting clinical information needed to make a determination is not sent to Independence promptly, regulatory rules will force us to issue a denial.

We look forward to partnering with you to carry out this change from CMS.

Learn more

If you have any questions, please contact Clinical Precertification at 1-800-ASK-BLUE (1-800-275-2583).

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