Transcription of PRIOR AUTHORIZATION MANUAL - Oklahoma …
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PRIOR AUTHORIZATION MANUAL - Oklahoma …
PRIOR AUTHORIZATION MANUAL FY 2018 PRIOR AUTHORIZATION MANUAL REVISIONS 1 GENERAL INFORMATION 2 SERVICES REQUIRING NO PRIOR AUTHORIZATION 2 GENERAL REQUEST INFORMATION 3 ODMHSAS PICIS HELP DESK 4 INFORMATIONAL WEB SITE FOR PROVIDERS 4 EDUCATIONAL OPPORTUNITIES 4 SOONERCARE ELIGIBILITY 4 PROVIDER ELIGIBILITY 5 NEWLY CERTIFIED FACILITIES/INDIVIDUAL PROVIDERS 5 MEMBER NAME AND/OR SOONERCARE ID NUMBER CHANGES 5 COLLABORATION BETWEEN OUTPATIENT BEHAVIORAL HEALTH PROVIDERS 5 APPEALS PROCESS 11 PRIOR AUTHORIZATION PROCESS BEHAVIORAL HEALTH AGENCIES 12 INSTANT PRIOR AUTHORIZATION 12 Pre-Admission Services 12 OUTPATIENT REQUEST FOR PRIOR AUTHORIZATION 14 Extra Unit BH Service Plan Development Low Complexity 14 Gambling 14 OJA Multi-Systemic Therapy 15 RBMS/TFC/Therapeutic Group Homes (Levels C&E) 15 Transitional Case Management 15 Health Home 15 Mobile Crisis 16 PATH 17 Continuation of Outpatient Services (Additional 6-Month PAs) 17 PA ADJUSTMENT 19 PRIOR AUTHORIZATION PROCESS INDIVIDUAL PROVIDERS 26 INSTANT PRIOR AUTHORIZATION 26 OUTPATIENT REQUEST FOR PRIOR AUTHORIZATION 26 TYPES OF AUTHORIZATION REQUESTS 27 PA ADJUSTMENT 27 SOONERCARE LIMITATIONS AND EXCLUSIONS 29 LEVELS OF CARE AND SPECIALIZED SERVICES 31 MEDICAL NECESSITY CRITERIA 33 CLIENT ASSESSMENT RECORD 55 ADDICTION SEVERITY INDEX (ASI) 68 CUSTOMER DATA CORE (CDC) 70
prior authorization manual revisions 1 general information 2 services requiring no prior authorization 2 general request information 3 odmhsas picis help desk 4
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