The Organization shall:

  1. Receive and document preauthorization from payers prior to starting services when applicable;
  2. Comply with reasonable concurrent and retrospective authorization requests from payers when applicable;
  3. Submit updated treatment plans in an accordance with internal policies or funder requirements to ensure continuity of care when seeking authorization for services;
  4. Make reasonable efforts to appeal adverse determinations that contradict recommendations from its qualified professionals; and
  5. Have a process in place to make patients or caregivers aware of their right to appeal and to provide a letter in support of the provider’s recommendations.