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Prior Authorization

Prior Authorization Cover Sheet

Often, prior authorization requests are not processed in a timely manner. As a result, third party administrators are violating Ohio state law. In an attempt to rectify this inadequacy, OAR has created a cover sheet for your practice to use when submitting your prior authorization requests. It is meant to serve as a reminder to the recipients of the requests that they have a defined amount of time to respond to requests per Ohio Code.

Prior Authorization Cover Sheet

The process for submitting complaints on prior authorizations to the Ohio Department of Insurance (ODI) has been causing difficulty for practices. Given this, OAR has created a set of directions to guide you while submitting your complaint. Additionally, OAR is collecting the complaint numbers that practices receive upon submission. OAR is keeping a record of the complaint numbers in order to follow up with the ODI on the frequency of complaints.

Under Ohio Insurance Law, insurers and plans have defined time limits in which they must respond to your rheumatology office’s Prior Authorization Requests.

You can file a Consumer Complaint, as a Provider, if the following occurs:

  • Your Urgent Prior Authorization Request was submitted to an insurer or plan and it was not approved or denied within 48 hours of the electronic receipt.
  • Your Non-Urgent Prior Authorization Request was submitted to an insurer or plan and it was not approved or denied within 10 calendar days of the electronic receipt.

Because there has been uncertainty on how to file a complaint on prior authorization violations, OAR has compiled information to guide you through the process of filing a Consumer complaint:

View Directions

You may also call ODI Consumer Services at (800) 686-1526 for assistance.

Consumer complaints regarding Prior Authorization violations may be filed online with the Ohio Department of Insurance. Below are some directions on how to file the complaint.

Submit a Complaint

  • Under “Contact Information”, fill out your basic contact information at the top of the online form.
  • Under “Insurance Information”, select “I am a healthcare provider submitting the complaint on behalf of a patient”.  Next, fill out the patient’s first and last name and their insurance information.
  • Under “Complaint Description”, enter the incident date and your complaint description and expected resolution.
  • Under “Complaint Reasons”, under the subtitle “Claim Handling”, select “No Preauthorization” and any one or two other reasons you may wish to select.
  • Any supporting documentation to support your complaint can be uploaded under the “Supporting Documentation” section (up to three documents).
  • Submit your complaint by agreeing to the terms at the bottom of the page. Record your complaint number.

Once you have submitted your Consumer complaint, we encourage you to remit your complaint number to our OAR Government Affairs office so the complaint numbers may be tracked. This process will allow for the OAR to follow-up with the Department on your behalf periodically.

Please remit your complaint number to our OAR Government Affairs office at info@ohiorheumatology.com.