{"id":9600,"date":"2020-07-15T07:18:49","date_gmt":"2020-07-15T07:18:49","guid":{"rendered":"https:\/\/cchphealthplan.com\/prior-authorization\/"},"modified":"2024-03-25T09:35:19","modified_gmt":"2024-03-25T16:35:19","slug":"prior-authorization","status":"publish","type":"page","link":"https:\/\/cchphealthplan.com\/es\/prior-authorization\/","title":{"rendered":"Proceso de autorizaci\u00f3n previa"},"content":{"rendered":"[vc_row type=&#8221;full_width_background&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; top_padding=&#8221;5%&#8221; bottom_padding=&#8221;5%&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; 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max_width_mobile=&#8221;default&#8221;][divider line_type=&#8221;No Line&#8221; custom_height=&#8221;20&#8243;][vc_custom_heading text=&#8221;Autorizaci\u00f3n previa para servicio m\u00e9dico&#8221; font_container=&#8221;tag:h2|text_align:center&#8221; use_theme_fonts=&#8221;yes&#8221;][divider line_type=&#8221;Small Line&#8221; line_alignment=&#8221;default&#8221; line_thickness=&#8221;2&#8243; divider_color=&#8221;accent-color&#8221; custom_height=&#8221;40&#8243; custom_height_tablet=&#8221;10&#8243; custom_line_width=&#8221;142&#8243;][\/vc_column_inner][\/vc_row_inner][vc_row_inner column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; text_align=&#8221;left&#8221; row_position=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; pointer_events=&#8221;all&#8221;][vc_column_inner column_padding=&#8221;padding-5-percent&#8221; column_padding_tablet=&#8221;no-extra-padding&#8221; column_padding_phone=&#8221;no-extra-padding&#8221; column_padding_position=&#8221;all&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;5px&#8221; column_link_target=&#8221;_self&#8221; overflow=&#8221;visible&#8221; el_class=&#8221;box-shadow&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221; column_padding_type=&#8221;default&#8221; gradient_type=&#8221;default&#8221;][vc_custom_heading text=&#8221;Las decisiones con respecto a las solicitudes de autorizaci\u00f3n ser\u00e1n tomadas solamente por m\u00e9dicos con licencia u otros profesionales m\u00e9dicos con la licencia apropiada.&#8221; font_container=&#8221;tag:h3|font_size:20|text_align:left&#8221; use_theme_fonts=&#8221;yes&#8221;][vc_column_text el_class=&#8221;small-padding&#8221; text_direction=&#8221;default&#8221;]\n<ul>\n<li>CCHP y su grupo m\u00e9dico participante tienen ciertos procedimientos para tomar la decisi\u00f3n de autorizaci\u00f3n dentro del marco de tiempo apropiado para su condici\u00f3n, pero a m\u00e1s tardar cinco d\u00edas h\u00e1biles despu\u00e9s de recibir toda la informaci\u00f3n (incluyendo ex\u00e1menes adicionales y resultados de pruebas) razonablemente necesarios para tomar la decisi\u00f3n. Las decisiones sobre servicios urgentes se tomar\u00e1n a m\u00e1s tardar 72 horas despu\u00e9s de recibir la informaci\u00f3n razonablemente necesaria para tomar la decisi\u00f3n.<\/li>\n<li>Si el Grupo M\u00e9dico necesita m\u00e1s tiempo para tomar la decisi\u00f3n porque no tiene la informaci\u00f3n que es razonablemente necesaria para tomar la decisi\u00f3n, o porque ha solicitado la consulta de un especialista en particular, usted y su m\u00e9dico tratante ser\u00e1n informados sobre la informaci\u00f3n adicional, las pruebas , o el especialista que se necesita, y la fecha en que el Grupo M\u00e9dico espera tomar una decisi\u00f3n. Su m\u00e9dico tratante ser\u00e1 informado de la decisi\u00f3n dentro de las 24 horas posteriores a la decisi\u00f3n tomada por tel\u00e9fono o fax. El plan notificar\u00e1 al m\u00e9dico y al Miembro por escrito dentro de los dos d\u00edas h\u00e1biles posteriores a la determinaci\u00f3n.<\/li>\n<li>Si el Grupo M\u00e9dico no autoriza todos los servicios, a usted se le enviar\u00e1 una decisi\u00f3n por escrito y una explicaci\u00f3n dentro de los dos d\u00edas h\u00e1biles posteriores a la toma de la decisi\u00f3n. La carta incluir\u00e1 informaci\u00f3n sobre sus derechos de apelaci\u00f3n, que se describen en la secci\u00f3n &#8220;Proceso de Quejas y Apelaciones&#8221; del formulario combinado de Evidencia de Cobertura y Divulgaci\u00f3n. Cualquier criterio por escrito que el Grupo M\u00e9dico utilice para tomar la decisi\u00f3n de autorizar, modificar, retrasar o denegar la solicitud de autorizaci\u00f3n estar\u00e1 disponible para usted cuando lo solicite. Una vez que CCHP autorice un tipo espec\u00edfico de tratamiento por parte de un proveedor, no rescindir\u00e1 ni modificar\u00e1 la autorizaci\u00f3n despu\u00e9s de que el proveedor preste el servicio de atenci\u00f3n m\u00e9dica de buena f\u00e9.<\/li>\n<\/ul>\n<p id=\"tw-target-text\" class=\"tw-data-text tw-text-large tw-ta\" dir=\"ltr\" data-placeholder=\"Translation\" aria-label=\"Translated text\" data-ved=\"2ahUKEwj674rK64-FAxXzFTQIHQlIDrYQ3ewLegQICBAU\"><a href=\"https:\/\/cchphealthplan.com\/wp-content\/uploads\/2024\/03\/41-UM-AUTH-600-Service-Auth-Request.pdf\"><span class=\"Y2IQFc\" lang=\"es\">Nuestra pol\u00edtica de autorizaci\u00f3n previa<\/span><\/a><\/p>\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row]\n","protected":false},"excerpt":{"rendered":"<p>[vc_row type=&#8221;full_width_background&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; top_padding=&#8221;5%&#8221; bottom_padding=&#8221;5%&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221; shape_type=&#8221;&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243;&#8230;<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/cchphealthplan.com\/es\/wp-json\/wp\/v2\/pages\/9600"}],"collection":[{"href":"https:\/\/cchphealthplan.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cchphealthplan.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cchphealthplan.com\/es\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/cchphealthplan.com\/es\/wp-json\/wp\/v2\/comments?post=9600"}],"version-history":[{"count":7,"href":"https:\/\/cchphealthplan.com\/es\/wp-json\/wp\/v2\/pages\/9600\/revisions"}],"predecessor-version":[{"id":45643,"href":"https:\/\/cchphealthplan.com\/es\/wp-json\/wp\/v2\/pages\/9600\/revisions\/45643"}],"wp:attachment":[{"href":"https:\/\/cchphealthplan.com\/es\/wp-json\/wp\/v2\/media?parent=9600"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}