How long does a Pre-existing Condition Review take?
Depending on the cooperation of the Member and the Provider, a Pre-Existing Condition Review can take up to 30 days or more.
The Clinical Review Team will request records when notified of the share request that needs to be reviewed for eligibility. A Medical Record request will be sent to the Provider. Once the records are received, the Clinical Review Team will conduct their Pre-Existing review and determine eligibility.