Diagnostic bronchoscopy. 8. Creation of arterial venous shunts (for hemodialysis). Failure to contact Blue Shield as described or failure to fol- low the recommendations of Blue Shield will result in an Note: Blue Shield or the MHSA will render a decision on all requests for prior authorization within 5 business days from receipt of the request. The treating provider will be notified of the decision within 24 hours followed by written notice to the provider and Subscriber within 2 business days of the decision. For urgent services in situations in which the rou- tine decision making process might seriously jeopardize the life or health of a Member or when the Member is experi- encing severe pain, Blue Shield will respond as soon as pos- sible to accommodate the Member’s condition not to exceed 72 hours from receipt of the request. additional payment per admission as described in the Addi- tional and Reduced Payments for Failure to Use the Benefits Management Program section or may result in reduction or non-payment if Blue Shield determines that the admission is not a covered Service.* *Note: For admissions for special transplant Benefits and for bariatric Services for residents of designated counties, failure to receive prior authorization in writing and/or fail- ure to have the procedure performed at a Blue Shield- Emergency Admission Notification If you are admitted for Emergency Services, Blue Shield should receive emergency admission notification within 24 hours or by the end of the first business day following the admission, or as soon as it is reasonably possible to do so, or you may be responsible for the additional payment as described under the Additional and Reduced Payments for Failure to Use the Benefits Management Program section. designated facility will result in non-payment of services by Blue Shield. See Transplant Benefits and Bariatric Surgery Benefits for Residents of Designated Counties in California under the Covered Services section for details. Prior Authorization for Inpatient Mental Health Services, Outpatient Partial Hospitalization, Intensive Outpatient Care and Outpatient ECT Services All Inpatient Mental Health Services, Outpatient Partial Hospitalization, Intensive Outpatient Care and Outpatient ECT Services, except for Emergency Services, must be prior authorized by the MHSA. For an admission for Emergency Mental Health Services, the MHSA should receive emergency admission notification within 24 hours or by the end of the first business day fol- lo...
