Behavioral Health Prior Authorization Process€¦ · RTC (Level 1) Admission • Initial...

Behavioral Health Prior Authorization Process For Providers

Topics • Submission Method • Prior Authorization Areas • Documentation requirements • Common documentation issues • Questions

2 Reaching across Arizona to provide comprehensive

quality health care for those in need

Submission Method • All documentation is accepted ONLY by Fax • Fax number: 602-253-6695 • Prior Authorization decision is faxed back to

the facility contact number listed on the PA Form.

3 Reaching across Arizona to provide comprehensive quality health care for those in need

DFSM Prior Authorization Requirements • Required Prior Authorization for the Fee-for

Service TRBHA members: o Acute Inpatient Admissions(Level 1) o Detox Facilities(Level 1) o Residential Treatment Centers(Level 1) o Arizona State Hospital

Other Facilities • All other facilities/levels of care DO NOT

require Prior Authorization, at this time. • Chart review might be conducted during

the audit process.

Documentation Requirements • All admissions require:

o Initial Authorization - CON o Continued Authorization – RON o Discharge Summary or Discharge Note with

aftercare instructions

Acute Inpatient Admission • Initial Authorization

o Fee for Service Prior Authorization Form o C.O.N (Certificate of Need) o Psychiatric Evaluation o Initial Treatment Plan

Court Ordered Evaluation • Title XIX/XXI funds must not be used • AHCCCS will cover:

o From the date of filing for COT o From the voluntary status date o C.O.N. should be submitted on the first day of

coverage with the documentation of the change of status

Acute Inpatient Admission • Continued Authorization

o Fee for Service Prior Authorization Form o R.O.N (Recertification of Need) o Medical Provider's Daily Progress Notes o Multidisciplinary Treatment Plan

Detox Admission • Initial Authorization

o Fee for Service Prior Authorization Form o C.O.N (Certificate of Need) o History and Physical o Psychiatric Evaluation, if available o Initial Treatment Plan

Detox Admission • Continued Authorization

o Fee for Service Prior Authorization Form o R.O.N (Recertification of Need) o Medical Provider's Daily Progress Notes o Multidisciplinary Treatment Plan

Acute Inpatient/Detox Admission • Initial Authorization – up to 3 days • Must be submitted within 72 hours of

admission • Continued Authorization – up to 7 days • Request for authorization must include the

date of admission and discharge • Forms must be filled out properly and

accurately 12 Reaching across Arizona to provide comprehensive

RTC (Level 1) Admission • Initial Authorization

o Fee for Service Prior Authorization Form Completed by Facility

o C.O.N (Certificate of Need) o Psychiatric Evaluation o Initial Treatment Plan o Other clinical document supporting non-

emergent RTC admission 13 Reaching across Arizona to provide comprehensive

RTC (Level 1) Admission • Continued Authorization

o Fee for Service Prior Authorization Form o R.O.N (Recertification of Need) o Medical Provider's Progress Notes o Multidisciplinary Treatment Plan

RTC (Level 1) Admission • Initial Authorization – up to 30 days • Continued Authorization – up to 30 days • Request for authorization must include the

date of admission and discharge • Forms must be filled out accurately • Statements must support request • PA Request must be received prior to

admission 15 Reaching across Arizona to provide comprehensive

Arizona State Hospital Admission • Initial Authorization(TRBHA coordinates)

o Fee for Service Prior Authorization Form – Completed by Facility

o Documents required from TRBHA C.O.N (Certificate of Need) Psychiatric Evaluation BHMP notes supporting placement Any other document supporting placement

Arizona State Hospital Admission • Continued Authorization – all documents

submitted to DFSM by ASH: o Fee for Service Prior Authorization Form o R.O.N (Recertification of Need) o Medical Provider's Progress Notes o Multidisciplinary Treatment Plan

Common Documentation Issues • ICD10 Diagnosis on FFS PA Form and on

C.O.N/R.O.N do not match • Unreadable/Incomplete documentation • Documentation does not support continuing

admission • Medical Providers signatures without printed

names and credentials • Lack of response from provider

18 Reaching across Arizona to provide comprehensive

Prior Authorization Phone Line

• 602-417-4400

Questions?

Thank You.

Behavioral Health Prior Authorization Process€¦ · RTC (Level 1) Admission • Initial...

Documents

Transcript of Behavioral Health Prior Authorization Process€¦ · RTC (Level 1) Admission • Initial...

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