How do I submit a retro authorization?
A retro authorization is needed when a service was already provided before the authorization was obtained.
Confirm you are within the submission window
Retro authorizations must be submitted within 30 calendar days of the date of service. Requests outside this window cannot be processed through the portal and will require a formal appeal.
Important deadline — The 30-day retro authorization window runs from the date of service, not the date you became aware the auth was missing. Contact Provider Relations immediately if you are approaching this deadline.
Navigate to New Authorization and select Retro
Go to Authorizations → New Authorization. At the top of the form, check the box labeled This is a retrospective authorization request. The form will update to include a required field for the date of service.
Enter the date of service
Enter the exact date the service was rendered. This field is required for all retro requests and cannot be a future date. The system will automatically calculate whether the request is within the 30-day submission window.
Complete the authorization form
Fill in the member information, service type, ICD-10 diagnosis code, and CPT procedure code as you would for a standard authorization. All fields are required.
Attach clinical documentation and a clinical rationale
In addition to standard clinical documentation, retro requests require a clinical rationale statement explaining why the authorization was not obtained prior to the service. Common acceptable reasons include emergency situations and system outages. Upload this as a separate PDF attachment.
Submit and note the confirmation number
Submit the request and save your confirmation number. Retro authorizations are reviewed on a case-by-case basis. Standard processing time is 5–7 business days. You will be notified by portal message when a decision is made.