Florida Medicaid

Authorization Requirements Policy Agency for Health Care Administration June 2016 Florida Medicaid Florida Medicaid Authorization Requirements Policy June 2016 i Table of Contents Introduction .. 1 Description .. 1 Legal Authority .. 1 Definitions .. 1 Authorization Requirements .. 2 When to Request Authorization .. 2 Where to Obtain Authorization .. 2 Who Can Request Authorization .. 2 Submission Requirements .. 2 Determination Process .. 3 Review criteria .. 3 Review Process .. 3 Notification .. 4 Final Arbiter .. 4 Appeals .. 4 Recipient Appeals .. 4 Reconsideration Requests .. 5 Florida Medicaid Authorization Requirements Policy June 2016 1 Introduction Description This policy contains general requirements for providers to obtain authorization to render Florida Medicaid services, when applicable. Florida Medicaid Policies This policy is intended for use by all providers that render services to eligible Florida Medicaid recipients through the fee-for-service delivery system, unless otherwise specified.

The QIO may use a national standardized set of criteria, or other set of criteria, approved by AHCA, as a guide for authorizations performed at the first review level.

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  Medicaid, Criteria, Florida, Florida medicaid

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