REQUESTS FOR AUTHORIZATIONS/RETRO-AUTHORIZATIONS
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Upon a request for authorization for services, by phone or fax transmittal, a letter confirming authorization of the requested service(s) should be received at the provider’s designated mailing address no later than ten (10) business days from the date of the request. If the provider is not in receipt of an authorization letter within ten (10) business days, the provider is to contact VBH-PA Customer Service at 1-877-615-8503 between 8:00 AM and 5:00 PM Monday through Friday.
If, for any reason, the provider finds it necessary to request a retro-authorization for service(s), the request must be received in writing no later than forty-five (45) calendar days from the date of service or date of discharge. The request for retro-authorization must be faxed (724-744-6329) to the attention of the Clinical Director or mailed to the attention of: Clinical Director, VBH-PA, 520 Pleasant Valley Rd., Trafford, PA 15085.
The request for a retro-authorization only guarantees consideration of the request. The provider will receive written notification within thirty (30) calendar days from VBH-PA’s receipt of the request, approving or denying the service. Any requests for retro-authorization(s) received beyond forty-five (45) calendar days from the date of service or date of discharge will not be given consideration.
If the provider received written approval for the retro-request for service(s) and has not previously submitted a claim, the provider should follow the procedures as outlined in the VBH-PA Provider Manual for submission of claims adjustments, outlined in Section VI of Claims Payment. The claim must be received by VBH-PA within ninety (90) calendar days from the date on the approval letter. If the retro-authorization request is billed as an initial claim, it may fall outside the timely filing requirements and will be automatically denied. If the provider has previously billed for the retro-authorization request and it was denied for “no authorization”, no action is necessary. VBH-PA will adjust the claim according to the authorization within thirty (30) calendar days of the retro-authorization approval.
Attached below is the Retro-Authorization form that needs to be completed and sent to the Clinical Director.
Retro Authorization Form (PDF)
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