Indiana  Care Select Program Prior Authorization Presented by ADVANTAGE Health Solutions, Inc. and MDwise, Inc. Mitchell E...
Today’s Agenda <ul><li>Prior Authorization (PA) Overview </li></ul><ul><li>What Requires PA   and Supporting Documentation...
PA Overview <ul><li>There are two Care Management Organizations (CMOs): </li></ul><ul><ul><li>ADVANTAGE Health Solutions, ...
PA Overview <ul><li>PA decisions can be appealed by the member and/or provider </li></ul><ul><li>Follow IHCP guidelines – ...
What Requires PA? <ul><li>Determine if a service or item requires PA in Traditional Medicaid and Care Select (CS): </li></...
<ul><li>PA must be submitted on the appropriate PA request form and be supported by appropriate medical necessity document...
PA Suspension/Denial Reasons <ul><li>Top 5 PA Suspension/Denial Reasons </li></ul><ul><li>Certificate of medical necessity...
<ul><li>Helpful Hints to Get Started for all PA: </li></ul><ul><li>Always verify eligibility on PA submision date  </li></...
How to Complete the Paper IPRAR Form <ul><li>How to access the form </li></ul><ul><li>Go to  www.indianamedicaid.com </li>...
How to Complete the IPRAR Form <ul><li>Note: Information found in the IHCP Provider Manual Ch 6, Section 2, p. 6-18 </li><...
How to Complete the IPRAR Form <ul><li>Mailing provider ID and Service Location –  </li></ul><ul><ul><li>If this field is ...
How to Complete the IPRAR Form <ul><li>Medical Diagnosis  </li></ul><ul><ul><li>Enter the primary and secondary ICD-9-CM d...
How to Complete the IPRAR Form <ul><li>Will DME be: Purchased/Rented/Repaired  </li></ul><ul><ul><li>Determine/Enter the t...
How to Complete the IPRAR Form <ul><li>Service Code –  </li></ul><ul><ul><li>Enter the requested code (i.e. CPTs, HCPCs, R...
How to Complete the IPRAR Form <ul><li>Units  </li></ul><ul><ul><li>Enter the number of units (i.e. days, months, or items...
How to Complete the IPRAR Form <ul><li>How to access the form </li></ul><ul><li>Go to  www.indianamedicaid.com </li></ul><...
How to Complete the IPRADR Form <ul><li>Note: Information found in the IHCP Provider Manual Ch 6, Section 2, p. 6-22 </li>...
How to Complete the IPRADR Form <ul><li>Mailing provider ID and Service Location  </li></ul><ul><ul><li>Note: If this fiel...
How to Complete the IPRADR Form <ul><li>Date of Service (Stop)  </li></ul><ul><ul><li>Enter the service stop date </li></u...
How to Complete the IPRADR Form <ul><li>Units  </li></ul><ul><ul><li>Enter the number of desired units </li></ul></ul><ul>...
How to Complete the IPRADR Form <ul><li>Circumstances (Place/Type)  </li></ul><ul><ul><li>Enter employment information, if...
How to Complete the IPRADR Form <ul><li>Periodontics – Briefly summarize the member’s periodontal condition </li></ul><ul>...
How to Complete the IPRADR Form <ul><li>Describe treatment if different from above –  </li></ul><ul><ul><li>Enter descript...
How to Complete the IPRADR Form <ul><li>Signature of Requesting Dentist –  </li></ul><ul><ul><li>The authorized provider m...
Prior Authorization <ul><ul><li>ADVANTAGE Health Solutions, Inc. sm </li></ul></ul><ul><ul><ul><li>www.advantageplan.com/a...
Web interChange Presented by HP <ul><li>The following provider types can submit PA requests via Web interChange: </li></ul...
Q&A <ul><li>Thank you for attending! </li></ul>
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Indiana Care Select Program Prior Authorization

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  • Speaker introductions Introductions of health plans MDwise Government sponsored healthcare in Indiana since 1994 Collaboration of Wishard and Clarian Health Partners 2. ADVANTAGE Health Solutions Has commercial and Medicare products Collaboration of several Catholic health systems (i.e. St. Vincent and St. Francis) 3. Both MDwise and ADVANTAGE are Care Select vendors since 2007 4. Purpose of today’s session is to talk about how to complete the paper and electronic PA forms (this has been a popular request) MDwise and ADVANTAGE will discuss the paper process while HP will lead us through the web interChange electronic submission.
  • Review the agenda Review when to ask questions (up to speaker…at end or during presentation) Ask if everyone received a handout/folder? Restroom locations
  • ADVANTAGE handles MRO PA for all members in the IHCP who meet the need for MRO including MDwise members. Review Ch 6 of the IHCP Provider Manual for your specialty specific PA requirements for Traditional and CS PA requests
  • Review Ch3 Of the IHCP Provider Manual for Web interChange usage guidelines Send the correct PA form to the correct vendor (i.e. start a PA and finish a PA with the same vendor) PA routed to the incorrect vendor will be rejected and sent back to the provider
  • Demonstrate using the web to check a code to determine if it needs PA. Remind audience that sometimes codes are used across provider specialties and that the provider specialty (i.e. podiatry and chiropractor) may require PA even though the code might show on the fee schedule as not requiring PA (i.e. 11750, 11721) Discuss instances where calling in PA is appropriate (i.e. inpatient substance abuse or psychiatric admissions). Use the fee schedule on the IHCP website to determine if a code requires PA; another source of service PA requirements is the IAC. Please do not call for PA status; all providers can use PA inquiry on the web; keeps staff from processing PA if all they do is answer phone calls Big picture PA questions can always be directed to provider relations at ADVANTAGE or MDwise
  • These items are critical to making a medical necessity determination If medical necessity cannot be determined, additional information may be needed and requested Expect some variation among the plans on determining medical necessity. Some might ask for a piece of information while another doesn’t but we should all arrive at mostly the same decision in most cases.
  • Bullet One Example: DME medical necessity forms (i.e. wheelchair or oxygen) Bullet Two Example: Home health plan of care not signed off on by physician Bullet Three Example: missing procedure codes (no plan will guess what your trying to accomplish and not our role to do that) Bullet Four Example: behavioral health plan of care or treatment plan must be included in medical documentation to see what issue the patient has, what type of treatment, and an evaluation of the success or lack thereof of that treatment signed off on by the HSPP or physician. Bullet Five Example: another plan or vendor PA form used or submitted to the wrong CS plan vendor.
  • Checking eligibility protects the financial well being of the practice Eligibility changes a lot Health plan is identified on the member’s eligibility response via web, phone, or OMNI Suspended PA auto denies after 30 days Submit pharmacy PA to ACS
  • Form located at www.indianamedicaid.com Only used for Care Select and Traditional Medicaid members Open up form and toggle back and forth between presentation and form while presenting Must be completed in its entirety and signed Can save the word version or adobe acrobat to hard drive Word version contains fields you can type directly into (eliminates need to hand write)
  • The PA decision letter is sent to the requesting or rendering provider’s NPI Provider must be enrolled in the IHCP Dual or billing provider (this needs to be checked) An alternate address can be placed on the PA request form
  • Use the provider’s NPI and not the legacy Medicaid provider ID
  • ICD 9 codebook can furnish the provider with an appropriate diagnosis….vendors cannot decide these. Certification period refers to a break in PA segments and not a member’s eligibility with the program. If this is a continuing service request, provider must check “No Gap in Certification”
  • Decisions on rental vs. purchase of an item based on the lowest cost to the program. Service start or stop dates must be provided by the provider but modified by the vendor (i.e. if a PA servicing period spans dates and some of those request dates are in the past, the vendor will modify the request start date to be the date of approval unless there is notification to the PA vendor by the provider for the vendor to consider a retroactive PA for reasons such as retroactive eligibility.
  • As mentioned, providers must supply the code and there are very few instances where a vendor would supply the code unless the IHCP mandates a certain code for a certain service. Failure to supply code could result in a denial. Vendors do not supply taxonomy codes; the provider must determine what those are if applicable.
  • Dollars might be necessary for Waiver covered services or DME in order to determine whether purchase is a better option than rental.
  • Open Dental PA form and toggle back and forth between presentation and form Word version of the document allows a provider to enter information rather than hand write PA for dental services for all ADVANTAGE CS, HHW and Traditional Medicaid members determined by ADVANTAGE. MDwise does PA for its CS membership
  • a copy of the PA decision letter is sent to the requesting or rendering provider’s NPI or the mail to provider indicated on the form
  • If the provider designates an address then this will be where the decision letter is mailed.
  • Place of service codes can be obtained from the dental procedure code book or the IHCP provider manual Ch8. A dental procedure code must be identified on the form and vendors will not supply this code.
  • A PA decision is not dependent upon the caseworker info being present.
  • Always refer to the health plan websites and the IHCP websites for information as mailings are now not regularly used to communicate with providers.
  • The web request will suspend for receipt of any required medical necessity documentation. HP will now demonstrate the web interChange PA submission process. Please welcome (HP rep) who will lead us through this part of the session.
  • Indiana Care Select Program Prior Authorization

    1. 1. Indiana Care Select Program Prior Authorization Presented by ADVANTAGE Health Solutions, Inc. and MDwise, Inc. Mitchell E. Daniels, Jr., Governor State of Indiana Indiana Family and Social Services Administration
    2. 2. Today’s Agenda <ul><li>Prior Authorization (PA) Overview </li></ul><ul><li>What Requires PA and Supporting Documentation </li></ul><ul><li>Common Reasons for PA Suspensions or Denials </li></ul><ul><li>How to Complete the Indiana Prior Review and Authorization Request Form </li></ul><ul><li>How to Complete the Indiana Dental Prior Review and Authorization Request Form </li></ul><ul><li>How to Complete a PA Request Using Web interChange </li></ul><ul><li>Questions & Answers </li></ul>
    3. 3. PA Overview <ul><li>There are two Care Management Organizations (CMOs): </li></ul><ul><ul><li>ADVANTAGE Health Solutions, Inc. sm </li></ul></ul><ul><ul><li>MDwise, Inc. </li></ul></ul><ul><li>Note: ADVANTAGE adjudicates all Traditional Medicaid and Medicaid Rehabilitation Option (MRO) PA requests </li></ul><ul><li>By contract, the CMOs are responsible for: </li></ul><ul><li>Processing PA requests </li></ul><ul><li>Making medical necessity determinations </li></ul><ul><li>Notifying providers and members of the determination </li></ul><ul><li>Basing PA decisions on OMPP approved guidelines </li></ul>
    4. 4. PA Overview <ul><li>PA decisions can be appealed by the member and/or provider </li></ul><ul><li>Follow IHCP guidelines – IHCP Provider Manual Ch. 6, Section 7 </li></ul><ul><ul><li>PA decision letters are mailed to the provider and member </li></ul></ul><ul><li>Provider letters sent to “mail to” address in Indiana AIM or PA request form </li></ul><ul><li>Required forms located at www.indianamedicaid.com in forms </li></ul><ul><li>Indiana Prior Review and Authorization Request (IPRAR) Form </li></ul><ul><ul><li>Medical and Behavioral Health </li></ul></ul><ul><li>Indiana Prior Review and Authorization Dental Request (IPRADR) Form </li></ul><ul><li>System Update Form </li></ul>
    5. 5. What Requires PA? <ul><li>Determine if a service or item requires PA in Traditional Medicaid and Care Select (CS): </li></ul><ul><li>Use the IHCP fee schedule: www.indianamedicaid.com </li></ul><ul><li>More information found in the IHCP Provider Manual Ch. 6, Indiana Administrative Code (IAC), bulletins, banner pages, and newsletters </li></ul><ul><li>Check PA status using PA inquiry function in Web interChange </li></ul><ul><li>Providers must submit PA request/supporting documentation via fax, web interChange, or mail </li></ul>
    6. 6. <ul><li>PA must be submitted on the appropriate PA request form and be supported by appropriate medical necessity documentation: </li></ul><ul><li>medical clearance form </li></ul><ul><li>treatment plan/plan of care </li></ul><ul><li>physician order </li></ul><ul><li>physician notes </li></ul><ul><li>Other documentation supporting medical necessity </li></ul>Types of Supporting Documentation
    7. 7. PA Suspension/Denial Reasons <ul><li>Top 5 PA Suspension/Denial Reasons </li></ul><ul><li>Certificate of medical necessity missing/incomplete </li></ul><ul><li>Home health plan of care missing/incomplete </li></ul><ul><li>Incomplete PA form </li></ul><ul><li>Missing physician orders </li></ul><ul><li>Clinical documentation missing </li></ul><ul><li>Incorrect form submitted </li></ul>
    8. 8. <ul><li>Helpful Hints to Get Started for all PA: </li></ul><ul><li>Always verify eligibility on PA submision date </li></ul><ul><li>Submit PA to the member’s health plan </li></ul><ul><li>PA decisions made within five (5) business days for CS and ten (10) business days for FFS </li></ul><ul><li>Suspended PA requests must be completed within 30 days by the provider </li></ul><ul><li>Fax the PA form along with supporting documents together </li></ul><ul><li>Web interChange allows providers to submit non-pharmacy PA requests </li></ul><ul><li>Mail – Submit PA request form along with supporting documents </li></ul>How to Complete PA Forms
    9. 9. How to Complete the Paper IPRAR Form <ul><li>How to access the form </li></ul><ul><li>Go to www.indianamedicaid.com </li></ul><ul><li>Select Forms from the right side of the web page </li></ul><ul><li>Scroll down to Prior Authorization </li></ul><ul><li>Select either the Word version or Adobe Acrobat version of the Prior Review and Authorization Form or the PA System Update Form </li></ul>
    10. 10. How to Complete the IPRAR Form <ul><li>Note: Information found in the IHCP Provider Manual Ch 6, Section 2, p. 6-18 </li></ul><ul><li>PA Form Field: </li></ul><ul><li>Requesting provider NPI </li></ul><ul><ul><li>– Enter requesting or rendering provider’s National Provider Identifier (NPI) </li></ul></ul><ul><li>Phone </li></ul><ul><ul><li>– Enter the phone number of the requesting or rendering provider’s NPI </li></ul></ul><ul><li>Mail to Provider </li></ul><ul><ul><li>Enter the address of the requesting or rendering provider </li></ul></ul>
    11. 11. How to Complete the IPRAR Form <ul><li>Mailing provider ID and Service Location – </li></ul><ul><ul><li>If this field is completed and the address is valid, the mailing provider ID and service location address receives the PA Decision Letter </li></ul></ul><ul><li>Rendering provider NPI/Name, Address, City, State, and Zip </li></ul><ul><ul><li>Enter the information for the provider rendering the service </li></ul></ul><ul><li>Managed Care Organization (MCO)/590/Fee-for-Service (FFS)/Care Select (CS) – </li></ul><ul><ul><li>Enter the program the member is eligible for on the date of service </li></ul></ul><ul><li>RID No/Date of Birth/Name, Address, City, State, and Zip </li></ul><ul><li> – Enter the information for the member who receives the service </li></ul>
    12. 12. How to Complete the IPRAR Form <ul><li>Medical Diagnosis </li></ul><ul><ul><li>Enter the primary and secondary ICD-9-CM diagnosis codes for the member receiving the service </li></ul></ul><ul><li>Is this a request for a continuing service? </li></ul><ul><ul><li>Check “yes” if this is a continuing service request or “no” if this is not a continuing service request </li></ul></ul><ul><li>Note: “Continuing Service” Defined as: </li></ul><ul><li>No break between two certification periods </li></ul><ul><li>(i.e. weekly or monthly) </li></ul>
    13. 13. How to Complete the IPRAR Form <ul><li>Will DME be: Purchased/Rented/Repaired </li></ul><ul><ul><li>Determine/Enter the transaction type and include any medical clearance forms </li></ul></ul><ul><li>Length of time DME required </li></ul><ul><ul><li>Regardless of transaction type, enter duration of need </li></ul></ul><ul><li>Has Service or Medical Supply Previously been Provided? - Enter “Yes”, Date, or “No” </li></ul><ul><li>Dates of Service Start – Enter requested start date </li></ul><ul><li>Dates of Service Stop – Enter requested stop date </li></ul>
    14. 14. How to Complete the IPRAR Form <ul><li>Service Code – </li></ul><ul><ul><li>Enter the requested code (i.e. CPTs, HCPCs, Revenue, or NDC…Please note these codes are required and must be furnished by the service provider) </li></ul></ul><ul><li>Modifier – Enter service modifier(s) </li></ul><ul><ul><li>Please note when required, these must be furnished by the service provider </li></ul></ul><ul><li>Requested Services </li></ul><ul><ul><li>Enter a short description (or include an attachment) of the requested service </li></ul></ul><ul><li>Taxonomy </li></ul><ul><ul><li>Enter any applicable taxonomy codes </li></ul></ul><ul><li>Place of Service (POS) </li></ul><ul><ul><li>Enter the place of service (POS) where the service will be rendered (i.e. clinic, home, etc) </li></ul></ul>
    15. 15. How to Complete the IPRAR Form <ul><li>Units </li></ul><ul><ul><li>Enter the number of units (i.e. days, months, or items depending on the service request) </li></ul></ul><ul><li>Dollars </li></ul><ul><ul><li>Enter the estimated or known IHCP cost of the item or service (Note: required for home health, DME, and pharmacy) </li></ul></ul><ul><li>Clinical Summary </li></ul><ul><ul><li>Enter clinical information pertinent to the service being requested </li></ul></ul><ul><ul><li>Note: treatment plan and progress notes and the dates of service should correspond to the treatment plan dates) </li></ul></ul><ul><li>Signature of Requesting Provider </li></ul><ul><ul><li>Authorized provider must sign and date the form (signature stamps acceptable) </li></ul></ul><ul><li>Note: Authorized provider can mean providers or authorized designees </li></ul>
    16. 16. How to Complete the IPRAR Form <ul><li>How to access the form </li></ul><ul><li>Go to www.indianamedicaid.com </li></ul><ul><li>Select Forms from the right side of the web page </li></ul><ul><li>Scroll down to Prior Authorization </li></ul><ul><li>Select either the Word version or Adobe Acrobat version of the Dental Prior Review and Authorization Form </li></ul>
    17. 17. How to Complete the IPRADR Form <ul><li>Note: Information found in the IHCP Provider Manual Ch 6, Section 2, p. 6-22 </li></ul><ul><li>Dental PA Form Field: </li></ul><ul><li>Requesting provider NPI </li></ul><ul><ul><li>Enter requesting or rendering provider’s National Provider Identifier (NPI) </li></ul></ul><ul><li>Phone </li></ul><ul><ul><li>Enter the phone number of the requesting or rendering provider’s NPI </li></ul></ul><ul><li>Mail to Provider </li></ul><ul><ul><li>Enter the address of the requesting or rendering provider </li></ul></ul>
    18. 18. How to Complete the IPRADR Form <ul><li>Mailing provider ID and Service Location </li></ul><ul><ul><li>Note: If this field is completed and the address is valid, the mailing provider ID and service location address receives the PA Decision Letter </li></ul></ul><ul><li>Managed Care Organization (MCO)/590/Fee-for-Service (FFS)/Care Select (CS) </li></ul><ul><ul><li>Enter the program the member is eligible for on the date of service </li></ul></ul><ul><li>RID No/Date of Birth/Name, Address, City, State, and Zip </li></ul><ul><ul><li>Enter the information requested for the member to receive the service </li></ul></ul><ul><li>Date of Service (Start) </li></ul><ul><ul><li>Enter the requested start date for the service (Note: continued service requests require a start date AFTER the previous PA’s end date) </li></ul></ul>
    19. 19. How to Complete the IPRADR Form <ul><li>Date of Service (Stop) </li></ul><ul><ul><li>Enter the service stop date </li></ul></ul><ul><li>Service Code – </li></ul><ul><ul><li>Enter the requested service code(s) </li></ul></ul><ul><li>Requested Service – </li></ul><ul><ul><li>Enter a short description of the service </li></ul></ul><ul><li>Place of Service </li></ul><ul><ul><li>Enter the location where the service will occur </li></ul></ul>
    20. 20. How to Complete the IPRADR Form <ul><li>Units </li></ul><ul><ul><li>Enter the number of desired units </li></ul></ul><ul><li>Dollars </li></ul><ul><ul><li>Enter the estimated or known IHCP cost of the service (optional) </li></ul></ul><ul><li>Caseworker </li></ul><ul><ul><li>Enter the member’s caseworker and phone number </li></ul></ul><ul><li>MCO/590/FFS/CS/MS </li></ul><ul><ul><li>Check member program </li></ul></ul><ul><li>Is the member employed? </li></ul><ul><ul><li>Check either YES or NO </li></ul></ul>
    21. 21. How to Complete the IPRADR Form <ul><li>Circumstances (Place/Type) </li></ul><ul><ul><li>Enter employment information, if applicable </li></ul></ul><ul><li>Is member in Job Training? </li></ul><ul><ul><li>Check either Yes or No </li></ul></ul><ul><li>Type of Job Training – </li></ul><ul><ul><li>Type training information, if applicable </li></ul></ul><ul><li>Dental Treatment Plan </li></ul><ul><li>Does the member have missing teeth? </li></ul><ul><ul><li>Check either Yes or No. If yes, indicate missing teeth with “X” on diagram </li></ul></ul><ul><li>Endodontics – </li></ul><ul><ul><li>Enter which tooth or teeth to be treated </li></ul></ul><ul><ul><li>Root canal therapy (1-32) </li></ul></ul>
    22. 22. How to Complete the IPRADR Form <ul><li>Periodontics – Briefly summarize the member’s periodontal condition </li></ul><ul><li>Partial Dentures </li></ul><ul><li>Date or dates of extractions of missing teeth, </li></ul><ul><li>tooth or teeth to be extracted (tooth #), </li></ul><ul><li>Tooth or teeth to be replaced (tooth #) </li></ul><ul><li>Description of materials and design of partial </li></ul><ul><li>Is member wearing partials now </li></ul><ul><li>age of current partial </li></ul>
    23. 23. How to Complete the IPRADR Form <ul><li>Describe treatment if different from above – </li></ul><ul><ul><li>Enter description of any treatment not previously listed on this form </li></ul></ul><ul><li>Is the member on any parenteral or enteral nutritional supplements? </li></ul><ul><ul><li>Check Yes or No </li></ul></ul><ul><ul><li>If yes, include treatment plan to wean member from nutritional supplements </li></ul></ul><ul><li>Brief dental/medical history – Enter relevant information about member’s medical and dental history </li></ul>
    24. 24. How to Complete the IPRADR Form <ul><li>Signature of Requesting Dentist – </li></ul><ul><ul><li>The authorized provider must sign and date the form (Note: Signature stamps are allowed) </li></ul></ul><ul><li>Date of Submission – </li></ul><ul><ul><li>Enter the date of actual submission to the member’s health plan </li></ul></ul>
    25. 25. Prior Authorization <ul><ul><li>ADVANTAGE Health Solutions, Inc. sm </li></ul></ul><ul><ul><ul><li>www.advantageplan.com/advcareselect </li></ul></ul></ul><ul><ul><ul><li>1-800-784-3981 – Care Select PA </li></ul></ul></ul><ul><ul><ul><li>1-800-269-5720 – Traditional PA </li></ul></ul></ul><ul><ul><li>ADVANTAGE was selected to function as the Traditional Medicaid fee – for–service and MRO Transformation PA administrator. </li></ul></ul><ul><ul><li>MDwise, Inc. </li></ul></ul><ul><ul><ul><li>www.mdwise.org </li></ul></ul></ul><ul><ul><ul><li>1-800-356-1204 – Care Select PA </li></ul></ul></ul><ul><ul><li>Note: All PA for prescription drugs are processed and adjudicated by ACS and not the CMOs </li></ul></ul>
    26. 26. Web interChange Presented by HP <ul><li>The following provider types can submit PA requests via Web interChange: </li></ul><ul><ul><li>Chiropractor </li></ul></ul><ul><ul><li>Dentist </li></ul></ul><ul><ul><li>Doctor of Medicine </li></ul></ul><ul><ul><li>Doctor of Osteopathy </li></ul></ul><ul><ul><li>Home Health Agency (authorized agent) </li></ul></ul><ul><ul><li>Hospice </li></ul></ul><ul><ul><li>Hospitals </li></ul></ul><ul><ul><li>Optometrist </li></ul></ul><ul><ul><li>Podiatrist </li></ul></ul><ul><ul><li>Psychologist endorsed as a Health Service Practitioner in Psychology (HSPP) </li></ul></ul><ul><ul><li>Transportation providers </li></ul></ul>
    27. 27. Q&A <ul><li>Thank you for attending! </li></ul>
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