Managing Pended Requests
Overview
Pending a request indicates that a decision cannot be made until further actions are completed. This could include soliciting additional information or documentation from the provider. This can also indicate that the request is waiting for a Medical Director Review. This guide focuses on the actions that can be done on a pended request.
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* Access to Utilization Management * Permission to edit requests and request status
When you need to move a request status from pend to a final decisioning status.
* Locate your request via your worklist, CPV or search functionality. * Know your role and whether that includes changing request statuses.
Decisioning by Service Line
You have the ability to change the status or each service line. This allows for the application of different statuses to each service or creating a split decision.
Locate the **Outcome** row below the requested service row.
If necessary, change the **Duration, duration unit of measure, From Date,** or **Units.**
The initial values are set based on the request. Adjust them if the decision differs from those values.
Select the appropriate **Status** from the drop-down menu.
Select the appropriate **Status Reason** from the drop-down menu.
Enter the appropriate rationale.
_Note:_ Rationale is optional for approved services.
_(Optional)_ Select the **Include in Letter** checkbox to allow the rationale to be included on letters sent for this request.
Click **Submit And Save Review.**
Alternate steps:* _C_lick **Save** to save the page and remain on the page to review or make additional pages.
* Click **Cancel** to leave the page without saving the outcome.
Bulk Approve All Services
You can save time by using the bulk features. If an action is not available for this particular request, the button is disabled.
Click **Approve All**.
Select the appropriate **Status Reason** from the drop-down menu. This status reason is applied to all services lines.
Click **Approve All.**
(_Optional)_ Enter your **Approval Rationale**. The service codes the rationale applies to are displayed below the header.
_(Optional_) Select the **Include in Letter** checkbox to include the approval rationale in letters sent for this request.
Click **Submit and Save Review**.
Alternate steps:* _(Alternate) C_lick **Save** to save the page and remain on the page to review or make additional pages.
* _(Alternate)_ Click **Cancel** to leave the page without approving any services.
Bulk Deny All Services
You can save time by using the bulk features. If an action is not available for this particular request, the button is disabled.
Click **Deny All**.
Select the appropriate **Status Reason** from the drop-down menu. This status reason is applied to all services lines.
Click **Deny All.**
Enter your **Denial Rationale**. The service codes the rationale applies to are displayed below the header.
_(Optional)_ Select the **Include in Letter** checkbox to include the denial rationale in letters sent for this request.
Click **Submit and Save Review.**
Alternate steps:* _(Alternate) C_lick **Save** to save the page and remain on the page to review or make additional changes.
* _(Alternate)_ Click **Cancel** to leave the page without denying any services.
Screen References
Clicking on any of the above headings will take you to the corresponding section within the request for your review.