Community Care Network, Inc. (22Healthplan) Prior Authorization

Community Care Network, Inc. (22Healthplan) prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Prior authorization is required for services on the plan’s PA list. Providers are directed to submit requests through the secure provider portal, PlanLink, and the request must include supporting clinical information. The plan states standard decisions are due within 15 calendar days when complete, and urgent decisions within 72 hours when complete, with possible extensions in limited circumstances.
• The official materials reviewed do not provide a complete code-level PA list in the extracted text; users must check the current PA list on the plan’s website.
• Most behavioral health outpatient services are stated not to require prior authorization, but the plan directs providers to verify by code on the PA list.
• The portal name and URLs appear in multiple forms (providerportal.22healthplan.com and planlink.ccpcares.org) across official materials.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3
• Verification resource 4

How to submit prior authorization requests

• Secure Provider Portal (PlanLink)

• Submission resource 1

• Submission resource 2

• Submission resource 3

Information commonly required

• Current information
• Patient history
• Progress notes (specialist notes)
• Lab results
• Imaging results
• Progress to treatment
• Doctor’s order

Turnaround notes and caveats

• Standard preauthorization: determination and written notice within 15 calendar days of receipt when all necessary information is received.
• Standard requests may be extended up to 15 additional calendar days if the member or provider requests an extension or the plan justifies the need for more information and explains the extension is in the member’s interest.
• Urgent preauthorization: determination within 72 hours when all necessary information is received; written notice within 3 business days.
• If additional information is needed for urgent requests, the plan requests it within 24 hours; the member or provider then has 48 hours to respond, and a determination is then provided within 48 hours, with written notice within 3 business days of receipt of the additional information.
• The official materials reviewed do not provide a complete code-level PA list in the extracted text; users must check the current PA list on the plan’s website.
• Most behavioral health outpatient services are stated not to require prior authorization, but the plan directs providers to verify by code on the PA list.
• The portal name and URLs appear in multiple forms (providerportal.22healthplan.com and planlink.ccpcares.org) across official materials.

Provider resources

• Provider Tools (official)
• Billing and Claims (official)
• Provider Portal PlanLink (official)
• Provider Manual (official)
• Important Contacts (official)
• Prior Auth Guidelines (official)

Sources