Golden Bay Health Plan delegates prior authorization request processing to North East Medical Services Management Services Organization (NEMS MSO). All UM decisions are based on the member’s benefit coverage and appropriateness of services.
UM Staff Availability
NEMS MSO UM staff are available to members and providers during regular business hours (Monday through Friday, 8:00am – 5:30pm) by calling 1(415) 352-5186, Option 1. To discuss UM issues and denial decisions, or to request a copy of the policies, procedures, and UM criteria, please call 1(415) 352-5186, Option 1. After normal business hours, UM staff can receive secure voicemail and fax. Please fax any UM related documents to the NEMS MSO UM fax line 1(415) 398-2895.
Prior Authorization Requests Submission
All requests for Prior Authorizations and the supporting clinical documentation, may be submitted by fax to the NEMS MSO UM fax line at 1(415) 398-2895 or through the NEMS MSO Provider Portal (EZ-NET).
TAR Turnaround Time
The standard turnaround time for processing prior authorizations is as follows:
| Medi-Cal | Medicare | |
|---|---|---|
| Routine Requests | Five (5) business days | Fourteen (14) calendar days |
| Urgent Requests | Within seventy-two (72) hours of receipt | Within seventy-two (72) hours of receipt |
| Retrospective Requests | Thirty (30) calendar days from date of receipt | Not accepted for Medicare |
For more information, please visit the NEMS MSO website.