The Organization shall:
- Receive and document preauthorization from payers prior to starting services when applicable;
- Comply with reasonable concurrent and retrospective authorization requests from payers when applicable;
- Submit updated treatment plans in an accordance with internal policies or funder requirements to ensure continuity of care when seeking authorization for services;
- Make reasonable efforts to appeal adverse determinations that contradict recommendations from its qualified professionals; and
- 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.
