Review Data Section

Enter review data.

Avatar MSO > Care Management > Authorization Appeal

1. In the Review Date field, enter the date the review was conducted.

2. In the New Dollar Amount field, enter the revised authorization dollar amount.

3. In the Committee decision field:

• Select Approved to reverse the denial.

• Select or Approved Administrative Certification to reverse the denial.

• Select Denied Per Plan Parameters if reversal is not necessary.

4. In the New Expiration Date field, enter the new expiration date for the authorization.

5. In the New Unit Amount field, enter the revised authorization number of units.

6. In the Other Coverage Changes field, enter an explanation of other changes in coverage.

7. In the Review Comments field, enter comments associated with the review.

8. Click View / Print Appeal Documentation to generate the authorization appeal and status letter, which details information entered in this form.