Page 44

Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 44

7.2.4 Decisions related to the prior authorization of health services are completed in accordance with state law or, in accordance with the medical needs of the patient, within 14 days after the receipt of a request for services. (Section 2102(a)(7)) (42CFR 457.495(d))

Decisions on prior authorization are made in accordance with the medical needs of the patient 14 days after receipt of a request for services. These are verified through spot checking and provider feedback, parent surveys, and reports from the Claims Processing Contractor.