Processing of Custom Power Wheelchair, Durable Medical Equipment, and Goal-Directed Therapy (Rehabilitative Services) Prior Authorization Requests
DADS published an information letter as a follow-up to the Claims Forwarding, Dental Billing, and Other Changes Related to the Nursing Facility Transition to Managed Care Long Term Care news article which was posted to TMHP.com on February 5, 2015. The news article indicated the Department of Aging and Disability Services (DADS) would provide additional information to nursing facility (NF) providers about the processing of Custom Power Wheelchair (CPWC), Durable Medical Equipment (DME), and Goal-Directed Therapy (Rehabilitative Services) prior authorization requests which are in-process after the STAR + PLUS NF transition occurs on March 1, 2015.
Prior Authorization Requests
For the March 1, 2015, transition to managed care and ongoing, STAR+PLUS managed care organizations (MCOs) are responsible for reviewing prior authorization requests for managed care members and making a determination regarding approval or denial. Providers should submit prior authorization requests to a resident’s MCO for non-emergency services provided outside of the Unit Rate (i.e. not included in daily care), including CPWC, DME, and Goal-Directed Therapy (Rehabilitative Services).
To do so, providers should utilize the appropriate STAR+PLUS MCO’s designated portal, contact the MCO directly, or visit the MCO website for information related to that MCO’s prior authorization process at:
· Amerigroup: https://providers.amerigroup.com/Providerdocuments
· Cigna-HealthSpring: https://starplus.hsconnectonline.com
· Molina: https://provider.molinahealthcare.com
· Superior: https://www.provider.superiorHealthPlan.com/sso/login · United Healthcare: http://www.unitedhealthcareonline.com
Custom Power Wheelchair Prior Authorization Requests
For the March 1, 2015, transition to managed care and ongoing, providers should contact a resident’s MCO concerning pending CPWC prior authorization requests. The Texas Medicaid Healthcare Partnership (TMHP) will provide CPWC prior authorization requests in progress to resident’s MCO to ensure continuity of care. NFs should not submit claims for reimbursement to TMHP for a managed care member after March 1, 2015.
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