Frequently Asked Questions
Click on a question below to reveal the answer.
How do providers submit cases for review?
The preferred method is through the Telligen provider portal.
How do I upload a medical record or provide other clinical documentation?
Providers should upload all clinical documentation through Telligen’s provider portal.
How can I check on the status of a review?
Providers can access Telligen’s 24/7 provider portal to check the status of case(s) submitted for review. Details on this functionality will be presented during the portal training sessions.
What constitutes a “technical denial?”
Technical denials are issued when the provider does not submit clinical information or other documentation necessary to complete the review. A technical denial will also be issued when requested information is not submitted within the defined time frame.
What medical necessity criteria does Telligen use?
Telligen uses MCG (formerly Milliman Care Guidelines).
Does Telligen perform prior authorization for medications?
Medication review is not included in Telligen’s scope of work.
Where can I see the decision letter that is attached to the review submitted through the Telligen Provider Portal?
For any review submitted through the portal, once a decision has been made, a letter will be attached to that review. The letter can be viewed by searching for the review using the Reference ID that was assigned to the case when it was created. Once you have located the review, click on the Reference ID link to open the Case Summary page. On that page, you will see the Reference ID link listed with details about the case letting you know what decision was made and when the decision was made. Click on the Reference ID again to open the Case Details Page. On the Case Details page, you will see a table that contains any letters that have been attached to the case. When you click on the letter, a PDF will open for you to view and read the letter. This PDF can be printed or saved for your reference.