Pre-authorizations and Organization Determinations

Part C Pre-Authorizations, Organization Determinations, and Reconsiderations (Appeals)

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, 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

If you don’t have a PDF reader installed, click on the link to download the latest version: