MHS recently made changes to our prior authorization (PA) list to help bring consistency to our code sets. Click here to check out the list of code removals and code additions! These changes will go into effect on February 1, 2012. Click here to see code changes.

Read more on MHS Changes to Prior Authorization List…

MHS is changing our transplant approval timeframes to align with all our other prior authorization approval timeframes and with the Indiana Health Coverage Programs regulations:

MHS is committed to processing all requests for prior authorization, including transplants, as quickly as possible, but in no event will we take more than seven (7) calendar days from the date we receive the request to render a decision If a prior authorization request does not include sufficient supporting information, MHS will reach out to the provider to obtain that information. Regardless, MHS will render its decision based on the information in hand by our deadline.

Read more on Transplant Providers: Update to Prior Authorization Approval Timeframe…

MHS Prior Authorization (PA) requirements for Durable Medical Equipment (DME) and therapy services clarification.

DME

• Contracted DME providers must obtain PA within 2 days following initiation of services.
• Non-contracted DME providers must obtain a PA no less than 2 days prior to initiation of services.

Read more on Prior Authorization of DME and Therapy Services Clarification…

Since September 2001, a prescriber’s specification of “brand medically necessary” has required prior authorization (PA) in order for Indiana Medicaid to reimburse for a prescribed brand-name product when a less expensive generic equivalent is available. Mental health drugs, however, were exempt from this requirement. Section 143 of House Enrolled Act 1001 of the recently concluded 2010/2011 Indiana General Assembly removed the exemption, so mental health drugs will require PA for “brand medically necessary,” as other drugs covered by the Indiana Health Coverage Programs (IHCP) do. [Read more on The IHCP to Require PA for Brand Medically Necessary Mental Health Drugs…