Timeliness of UM Decisions

MedStar Family Choice (MFC) is an accredited MCO through NCQA (National Committee for Quality Assurance). As such, we follow standards set forth by NCQA or Maryland Department of Health, whichever is stricter.

In accordance with NCQA Standard UM 5, Timeliness of UM Decisions, MedStar Family choice will follow the following timeframes:

Initial Request for Inpatient Authorization

In situations where MFC receives requests for inpatient authorization accompanied by clinical review, MFC will communicate a decision within 72 hours (3 calendar days) of receipt of your request.

A face sheet that is not accompanied by any clinical will not be considered a formal request. MFC will attempt to request clinical, but if clinical is not received it will not be entered into our clinical software system.

Concurrent Review

In situations where MFC receives requests for additional urgent concurrent care that is accompanied by clinical review, MFC will communicate a decision within 72 hours (3 calendar days) of receipt of your request.

Post initial review, MFC will document on the Daily Communication Log, the next scheduled review date. Clinical not received on the scheduled review date may be subject to denial. MFC may elect to grant an extension for up to 14 calendar days to receive the clinical.

Information current as of: 07/19/21