Prior Authorization (PA)
Overview
Prior authorization (PA) is required for certain covered
services to document the medical necessity for those services. To
determine if a procedure code requires PA, access the fee schedule. Chapter 6 of the
IHCP Provider Manual provides detailed instructions regarding
the PA process and procedures, as does Best Practices: Nonpharmacy
PA on this Web site.
Submitting a PA Request
When you need a PA, complete the appropriate form and fax it to
the appropriate care management organization, as shown in the Prior Authorization Attachment Address
Table.
| Prior Authorization - System Update Request Form |
Acrobat |
Word |
October 2007 |
| Prior Review and Authorization Dental Request Form |
Acrobat |
Word |
October 2007 |
| Universal Prior Authorization Request Form |
Acrobat |
Word |
January 2011
|
| Universal Prior Authorization Request Form - Instructions |
Acrobat |
|
October 2010 |
| Medicaid Appeal Request Form |
Acrobat |
Word |
December 2009 |
Appealing a PA Decision
You can request an appeal of a PA decision. See Chapter 6 of the
IHCP Provider Manual for instructions.
Pharmacy PA Requests
To request pharmacy PA, see the pharmacy PA forms on the Forms page of this site.
For more information, see
Chapter 9 of the IHCP Provider Manual.