Pre-authorizations and Organization Determinations
As a Brand New Day member you can request a self-referral (pre-authorization) to see a specialist or receive medical services and items. Typically, your provider will do this for you.
When you or your provider send a pre-authorization, Brand New Day reviews and makes an organization determination. An organization determination is the first decision Brand New Day makes about covering a medical service or item you’ve requested.
If the pre-authorization is a standard request, we will notify you of a decision within 14 calendar days (72 hours for Standard Part B Drug requests).
There are times where you or your provider may submit an expedited pre-authorization for a fast organization decision. An expedited pre-authorization qualifies for a fast decision if we determine that your life, health, or ability to regain maximum function may be seriously jeopardized by waiting for a standard request.
If the pre-authorization is an expedited request, we will notify you of a decision within 72 hours (24 hours for Expedited Part B Drug requests).
Where do I send my pre-authorization and/or request for an organization determination?
Please see below how you or your provider can submit a pre-authorization for an organization determination on medical services and items.
Click here to download a PDF version of the Pre-Authorization Form.
If you don’t have a PDF reader installed, click on the link to download the latest version Adobe Acrobat PDF Reader.
|Brand New Day Member Services Department contact information
|Hours of Operation:
Monday – Friday, 8 a.m. – 8 p.m.
October 1 – March 31
Monday – Sunday, 8 a.m. – 8 p.m.
||Brand New Day
Attn: Utilization Management
PO Box 93122
Long Beach, CA 90806
If you don’t agree with our decision on your denied pre-authorization, you have the right to file an Appeal. For more information on how to file an appeal please visit the How to File an Appeal site page under Members.
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