As a Brand New Day member you can request a self-referral (pre-authorization) to see a specialist or receive medical services and items. Typically, your provider will do this for you.

When you or your provider send a pre-authorization, Brand New Day reviews and makes an organization determination.An organization determination is the first decision Brand New Day makes about covering a medical service or item you’ve requested.

If the pre-authorization is a standard request, we will notify you of a decision within 14 calendar days (72 hours for Standard Part B Drug requests).

There are times where you or your provider may submit an expedited pre-authorization for a fast organization decision. An expedited pre-authorization qualifies for a fast decision if we determine that your life, health, or ability to regain maximum function may be seriously jeopardized by waiting for a standard request.

If the pre-authorization is an expedited request, we will notify you of a decision within 72 hours (24 hours for Expedited Part B Drug requests).

Where do I send my pre-authorization and/or request for an organization determination?

Please see below how you or your provider can submit a pre-authorization for an organization determination on medical services and items.

Download Forms

Click here to download a PDF version of the Pre-Authorization Form.

If you don’t have a PDF reader installed, click on the link to download the latest version Adobe Acrobat PDF Reader.

English Spanish

Appeals (Reconsiderations)

If you don’t agree with our decision on your denied pre-authorization, you have the right to file an Appeal. For more information on how to file an appeal please visit the How to File an Appeal site page under Members.

You will need Adobe Acrobat Reader to view the documents on this page. Click here to download it now.