Expedited / Urgent Request Guidelines
CMS defines an expedited/urgent request as ‘an expedited/urgent request for a determination is a request in which waiting for a decision under the standard time frame could place the member's life, health or ability to regain maximum function in seriously jeopardy.' Contracted providers should submit requests in accordance with CMS guidelines to allow for organization determinations within the standard turnaround time, unless the member urgently needs care based on the CMS definition of an expedited/urgent request
Affirmative Statement
Utilization Management decision-making is based only on appropriateness of care and service and the existence of coverage. The delegate does not specifically reward practitioners or other individuals conducting utilization reviews for issuing denials of coverage. Financial incentives for Utilization Management decision-makers do not encourage decisions that result in under-utilization.
Confidentiality Notice
The protected health information contained on this website is HIGHLY CONFIDENTIAL. The contents of the website are intended for the exclusive use of authorized providers of Nivano Physicians. It is to be used only to aid in providing specific healthcare services. Any other use is a violation of Federal Law (HIPAA) and will be reported as such. If you are not the intended user, you are hereby notified that any dissemination, distribution, or copying from this website is strictly prohibited.
EZ-NET Provider Portal Redesign
The provider portal has a new layout! All the same features are available in a new and easy to use format! To log in, please click on the "Login" button in the upper right corner of the screen to check/submit authorizations and check claim status.
** If you need to verify eligibility, please utilize the patient's health plan website **