No Status Update on Prior Authorization? Here’s What to Do

• Potential Causes for Delayed or Missing Authorization Responses
• What is a Status Check?
• Before Requesting a Status Check: What to Check First
• When Should You Request a Status Check?
• How to Request a Status Check?
• What Happens Next?

When there’s no movement on a prior authorization request, it’s important to know the right steps to take. This guide helps you check for common issues and decide when and how to request a status update. 

Potential Causes for Delayed or Missing Authorization Responses

• Fax and Communication Delays: Occasionally, payers may send faxes to a different number than what is listed on the form. Additionally, the fax may have been forwarded to another internal department at the payer, which can cause delays.
• Fax Not Accepted: Some payers no longer accept faxes for authorizations, so submissions sent by fax may not receive a response.
• Existing Authorization: If there is already an authorization on file for the patient, the payer may not respond to a duplicate request.

What is a Status Check?

• A status check is when we contact the payer on your behalf because no response has been received regarding your authorization request. This helps ensure your request is being processed and not overlooked

Before Requesting a Status Check: What to Check First

Before requesting a status check, please:

• Review the notes in the authorization to confirm that there are no comments pending your attention

• Check the standard turnaround time for your payer.
  • Most payers have a set timeframe for processing authorization requests. Ensure this time has passed before reaching out (unless urgent)
• Confirm the Samacare Authorization ID and Member ID Number are accurate and match your records.
• Verify that the authorization was sent to the correct state and payer (for example, Anthem/BCBS of the correct state).

Example View

When Should You Request a Status Check?

• The standard turnaround time for your payer has passed and you still have not received a response.
• Your request is urgent (for example, if the patient’s health may be at risk.
• You have checked all the items above and still have not received any updates.

How to Request a Status Check When There Is No Update

• To request a status check, simply contact us via email or chat and provide the following details:
  • Samacare Authorization ID
  • Phone Number located on the back of the member's ID.

          Our team will then follow up with the payer to obtain an update on your authorization request.

Example View

What Happens Next?

• After you provide the necessary information, our team will:
  •  Follow up with the payer for a status update. 
  • Any updates or relevant information will be sent to you via email and also documented in the notes within the authorization.

We're here to guide you through your prior authorization quest!