Important Tips on How to Prevent Delays in the Authorization Process

Documentation is important. Be sure to include medical history that supports the medical necessity of the service being requested. Requests will be delayed without it. Documentation can be supplied three ways:
1. The most efficient method is to use our web portal (REA). Do not fax as it delays processing.
2. Copy and paste them from NextGen to the notes section of the authorization.
3. Type the needed information in the notes.
Check eligibility.
Ensure you are selecting a specialist from the drop down menu.
Include referring physician and provider/facility that is to provide the service.
Include procedure (CPT) and diagnosis codes.
Select the correct urgency. Unless there is an actual medical emergency, the request should be submitted as “Routine.” Submitting non-medically urgent referrals as “Urgent” delays processing for those that are urgent.
Select providers that appear for the member in their referral network. Do not select “Provider not listed” unless there are no providers in their network that can provide the requested service. To avoid delays and calls from the department requesting further information, provide an explanation for the use of this provider.
Regularly follow up within 48-72 hours to ensure timely approval. Date and time stamp all prior authorization submission materials and store in a tickler file or enter a reminder in the electronic health record.

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule affords members the right to receive a notice that describes how health information may be used and disclosed and how to get access to this information. Regal Medical Group (RMG) is required to send a notice ("Notice of Privacy Practices") to members of our insured Health and Long Term Care plans.

Notice of Privacy Practices

Personal Information Collection and Use:

RMG welcomes you to their website. All information that is collected on our website is done on a voluntary basis. All non-public personal information that you provide via our website will be used strictly for the purpose stated on the page where it is collected. RMG will not sell, license, transmit or disclose this information outside of RMG or our affiliated companies unless (1) required or permitted by law, (2) expressly authorized by you, or (3) necessary to enable RMG contractors or agents to perform certain functions for us. With all disclosures, we will disclose information consistent with applicable law and regulations and we will require the recipient to protect the information and use it only for the intended purpose.

"Personal Information" is defined as data that is unique to an individual, for example: name, address, member id, date of birth, or telephone number. There may be occasions where we may request personal information on our website in order to provide services or respond to your questions.

E-mail Communications

Feedback and questions are always welcome on our website. We have provided e-mail boxes for that purpose. Your feedback and questions will be shared with our customer service representatives and those employees most capable of addressing your feedback and questions.

Please note e-mail, like most, if not all, non-encrypted Internet e-mail communications, may be accessed and viewed by other Internet users, without your knowledge and permission, while in transit to us. For that reason, to protect your privacy, please do not use e-mail to communicate information to us that you consider confidential. If you wish, you may contact us instead via non-cellular telephone at the numbers provided on our Contact Us page or Member Services at 866-654-3471.

We have made some locations on our website secure, so you can exchange non-public personal information with us. You will be provided appropriate instructions at each of these locations.

Linking to Other Sites

RMG's website may provide links to other websites, that are not owned or maintained by RMG, that we think might be useful or of interest to you. These other websites will open in a separate browser window. We are not responsible for the privacy practices used by other websites, the content, or accuracy of the other websites. These links to other non-RMG websites do not constitute or imply endorsement by RMG of these websites, any products or services described on these sites, or of any material contained in them.

Security

RMG has adopted and adheres to stringent security standards designed to protect non-public personal information at regalmed.com against accidental or unauthorized access or disclosure. Among the safeguards that RMG has developed for this site are administrative, physical and technical barriers that together form a protective firewall around the information stored at this site. We periodically subject our site to simulated intrusion tests and have developed comprehensive disaster recovery plans.

Changes to this Statement

RMG may change this Statement from time to time without notice. This Statement is not intended to and does not create any contractual or other legal rights in or on behalf of any party.

Legal Statement

Disclaimer

All information provided on this web is "AS IS" without warranty of any kind, either express or implied warranties of merchantability, fitness for a particular purpose, or non-infringement. Some jurisdictions do not allow for the exclusion of implied warranties, so the exclusion above may not apply to you. The data set forth herein is for informational purposes only, and no warranty is made that the information is error-free. Please note that once you leave this site, either by using a link we may have provided for your convenience or by specifying your own destination, RMG accepts no responsibility for the content, products and/or service provided at these non-RMG locations. RMG does not control, endorse, promote, or have any affiliation with any other website unless expressly stated herein.

Liability

RMG will not be held liable to any party for any direct, indirect, special, or other consequential damages arising from any use of this website, or any linked website, including, without limitation, any loss of profits, business interruption, loss of programs or data on your equipment, or otherwise, even if we are expressly advised of the possibility or likelihood of such damages.

Changes to This Website

Information may be changed or updated without notice. RMG has no obligation to update information presented on this website, so information contained herein may be out of date at any given point in time. RMG may also make improvements and/or changes in the services and/or programs described in this information at any time without notice.