2021 VHP Provider Manual

Page 144

Back to Chapter 17 Table of Contents

Chapter 17 Includes: (Continued) Alert Alert draws attention to critical information that has changed this year.

17. Authorization Considerations 18. Medical Necessity 19. Clinical Decisions

Contact Contact information on who to contact for assistance.

20. Authorization Determination Timeframes 21. Notification of Decisions

Book Table of Contents Click the purple VHP circle logo, located at the bottom left corner, to return to the main TOC.

22. Responding to Adverse Determinations 23. Continuity of Care 24. Second Opinions 25. Assistant Surgeon 26. Emergency Services 27. Requirement for Inpatient Admission 28. Acute Inpatient Rehabilitation and Long-Term Acute Care Admission 29. Inpatient Admission to Sub-acute and Skilled Nursing Facilities 30. Disclosure of Utilization Management Criteria

p.139

CH 17: Utilization Management

2021 / Provider Manual


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