AFMC’s contracts to perform reviews with public and private health plans include strict timelines for completion. As these contracts become more and more competitive, we must assure timeliness and adhere to contractually binding, specified turn-around times.
How do these timelines affect therapist reviewers?
As an independent contractor for therapy services, you can help by returning your reviews by designated deadlines. Please let us know if you cannot complete reviews in a timely manner. If a review has been issued to you and something has changed with your time schedule, we will attempt to re-assign to another reviewer who can meet our required timeframe. Reviews that are not completed within required timeframes means we will not be able to meet contractual deadlines.
Contractual timelines are:
- Therapy EOB/PA and Acute Rehab requests must be completed within 72 hours
- Therapy Retro requests must be completed within 30 calendar days
- Therapy EOB/PA/Acute Rehab referrals that are assigned to you as a therapist advisor should be completed with 24-36 hours, to allow for physician review, if necessary.