Upon receipt of a request for authorization for services, by phone, electronic, or fax transmittal, VBH-PA has ten (10) business days to enter a provider’s authorization. Providers will be notified electronically via ProviderConnect when new authorization letters are available. Providers should be able to access authorizations within 2 business days of a decision. An icon will appear on the ProviderConnect home page indicating that new authorization letters are available. Click on the link on the ProviderConnect home page to go to links to new authorization letters. Print the letters or save them to your computer. Only approval letters are electronic. Adverse determination letters and return of incomplete requests will continue to be sent to providers via US Mail. Providers without a computer can request a fax-back copy of an authorization letter via touch tone telephone. Call 1-866-409-5958 and have available the provider NPI, fax number to receive the fax-back document, consumer ID number, authorization dates requested, and authorization number (if obtained previously).
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.
Payment for Retro-Authorizations
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)