{"id":8821,"date":"2025-12-04T15:21:22","date_gmt":"2025-12-04T15:21:22","guid":{"rendered":"https:\/\/hnetalk.com\/provider\/?p=8821"},"modified":"2025-12-04T15:21:22","modified_gmt":"2025-12-04T15:21:22","slug":"retrospective-review-authorization-policy-december-2025","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/retrospective-review-authorization-policy-december-2025\/","title":{"rendered":"Retrospective Review Authorization Policy (December 2025)"},"content":{"rendered":"<p>Health New England will review retrospective authorization requests in limited circumstances, as described below.<\/p>\n<ul>\n<li>When the member has been added retrospectively to HNE after services have been provided or during a course of continuing treatment; or<\/li>\n<li>The member has been referred or received same day services; or<\/li>\n<li>The service was urgent or emergent in nature; and\/or<\/li>\n<li>Enrollment with HNE\/eligibility and\/or member benefit unable to be verified; or<\/li>\n<li>Non-emergent ambulance transportation.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>There must be documentation on the request indicating the reason the service was requested retrospectively.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Health New England will review retrospective authorization requests in limited circumstances, as described below. When the member has been added retrospectively to HNE after services have been provided or during a course of continuing treatment; or The member has been referred or received same day services; or The service was urgent or emergent in nature; [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[92],"tags":[],"class_list":["post-8821","post","type-post","status-publish","format-standard","hentry","category-provider-newsletter"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-2ih","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8821","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=8821"}],"version-history":[{"count":3,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8821\/revisions"}],"predecessor-version":[{"id":8824,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8821\/revisions\/8824"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8821"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8821"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8821"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}