CMS reminder: Expedited/urgent requests
The Centers for Medicare & Medicaid Services (CMS) define an expedited/urgent request as:
“An expedited/urgent request for a determination is a request in which waiting for a decision under the standard time frame could place the member's life, health or ability to regain maximum function in seriously jeopardy.”
Contracted providers should submit requests in accordance with CMS guidelines to allow for organization determinations within the standard turnaround time, unless the member urgently needs care based on the CMS definition of an expedited/urgent request.
November 2019 Anthem Provider News - Virginia