Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
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6/8/23  12:01 pm
Commenter: Anonymous


Case managers must, "Gather materials to document that the member meets the medical necessity criteria for the service and submit the documentation for review and authorization of reimbursement." 

Is there a time frame in which the reviewer has to review and authorize/not authorize the approval and communicate this to the submitting case manager? Will there be opportunity for the CM to submit additional information if the authorization is initially denied? 

CommentID: 217095