Expedited Organization Determination
An expedited organization determination is a fast decision by a Medicare Advantage plan on whether it will cover a requested service. When waiting for a standard decision could seriously jeopardize the enrollee's life, health, or ability to regain function, the plan must generally decide within 72 hours.
Definition
An expedited organization determination is a fast decision by a Medicare Advantage plan on whether it will cover a requested service. When waiting for a standard decision could seriously jeopardize the enrollee's life, health, or ability to regain function, the plan must generally decide within 72 hours.
Why it matters
Clinicians requesting urgent authorizations for Medicare Advantage patients should invoke the expedited process and document the clinical urgency to avoid harmful delays.
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