Posts Tagged: prior authorization

Clarification of DME Codes requiring Prior Authorization effective July 1, 2014

Posted by & filed under Blog, Provider News.

Previously MHS sent notification in regards to PA changes effective July 1, 2014. This is to clarify that the codes listed in that notice are NEW to the DME PA list as of July 1, 2014. These codes were “added” to the current list of DME codes requiring PA. MHS publishes the entire codes ranges of all DME codes, as well as other services, that require PA on the MHS Quick Reference Guide, which can be found on the Provider Guides page. For your convenience the entire list of DME codes that require PA is included in this blog post. If you have any questions, please contact MHS at 1-877-647-4848.

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Authorization Requirements Updates October 16, 2014

Posted by & filed under Blog, Provider News.

Attention:

Managed Health Services (MHS) is making updates to our 2014 authorization requirements. We apologize for the inconvenience as the enterals were incorrectly removed from the prior authorization requirement list as of July 1, 2014. Due to the high volume of enteral request and medical necessity review needed, we will require authorization for MHS contracted and non-contracted providers for the following codes effective October 16, 2014. Thank you for your patience and cooperation.

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Online Prior Authorization Tool Now Available

Posted by & filed under Provider News.

MHS is pleased to introduce a new tool for our Providers. Effective immediately, providers now have the ability to check prior authorization requirements for services through our website. Simply choose the link “Pre-Auth needed?” under the “For Providers” section on the website and type in the CPT code or HCPC code in the question for authorization requirements section. Once you hit submit, you will be provided with the following:

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Transplant Providers: Update to Prior Authorization Approval Timeframe

Posted by & filed under Provider News.

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.

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Prior Authorization of DME and Therapy Services Clarification

Posted by & filed under Provider News.

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.

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The IHCP to Require PA for Brand Medically Necessary Mental Health Drugs

Posted by & filed under Provider News.

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. [http://provider.indianamedicaid.com/]

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