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90-day specialty provider transition of care
What is Transition of Care?
Transition of care is a one-time consideration to help ease your transition to plan providers and to best medically manage your medical conditions. The transition-of-care process is for active therapy that you are currently receiving and requires approval by a Prevea360 Health Plan Medical Director.
To be considered for this 90-day transition period, a new member must be in active treatment with an out-of-network specialty provider before your plan’s effective date and have a scheduled appointment within the first 90 days of the plan’s effective date.
How it works:
- You must submit the transition-of-care form no later than 14 days after your plan's effective date. You may submit prior to your effective date. Forms must be submitted prior to any services being rendered. Prevea360 Health Plan's medical management reviews the information supplied and assesses whether your care qualifies for a transition-of-care authorization. Submission of this form does not guarantee authorization approval for services with out-of-network providers.
- You or your dependent will be contacted by a Prevea360 Health Plan representative regarding your transition-of-care request within seven business days. If you are not contacted within seven business days you should contact our Customer Care Center.
- If your transition of care is approved, Prevea360 Health Plan will facilitate the initial prior authorization, indicating any limitations or special instructions regarding the request. You will receive a written authorization letter.
What is NOT considered for transition of care?
- Primary-care-provider visits with a non-plan provider.
- Any care rendered more than 30 days before your effective date with a non-network specialty provider.
- Any specialty care scheduled 90 days and beyond after the effective date of the new plan.
If you believe you may qualify, please complete and submit the Transition-of-Care Request Form. For any questions regarding this process, please contact our Customer Care Center at 877-232-9375.