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Part A Prior Authorization Status Update Requests
NGS has noticed an increase in calls to the NGS Provider Customer Service Department requesting an update on the status of a prior authorization request that was made within the last few days. Please understand that the standard review timeframe for response to a Prior Authorization request is ten business days, excluding federal holidays, from the date that a valid prior authorization request is received by NGS.
If the standard timeframe for making a decision could seriously jeopardize the life or health of the beneficiary then you may request an expedited prior authorization. The expedited request must include justification showing that the standard timeframe would not be appropriate. The timeframe for an expedited review decision is up to two business days, excluding federal holidays, from the date that the expedited prior authorization request was received by NGS.
Do note that if NGS determines that the request does not substantiate the need for an expedited review.
Other scenarios where an expedited request will not be substantiated as expedited when:
Surgery is scheduled for the same/next day after the initial prior authorization request was submitted
An expedited Prior Authorization request is submitted due to inattention to submitting the prior authorization request timely
NGS will provide notification and communicate a decision within the regular timeframe of 10 business days from the date the request was received by NGS.
Did you know that you can initiate and check the status of your Prior Authorization requests in NGSConnex? It is easy and quick to both submit and check the status of your Prior Authorization requests using NGSConnex! Save yourself time by using NGSConnex to avoid the wait time often necessary when you contact NGS Provider Customer Service.
For additional information on how to use NGSConnex, as well as how to initiate and check the status of your prior authorization request:
Additional information on prior authorization for certain hospital outpatient department services: