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9.5 Ease of Setup DocHub User Ratings on G2 9.0 Ease of Use DocHub User Ratings on G2 The fastest way to redact molina prior authorization form online Dochub is the best editor for modifying your paperwork online. Adhere to this straightforward instruction to redact molina prior authorization form in PDF format online free of charge:Register and sign in. Register for a free account, set a strong password, and go through email verification to start managing your templates.Add a document. Click on New Document and choose the form importing option: add molina prior authorization form from your device, the cloud, or a protected URL.Make adjustments to the sample. Utilize the top and left panel tools to redact molina prior authorization form. Add and customize text, pictures, and fillable fields, whiteout unnecessary details, highlight the important ones, and comment on your updates.Get your paperwork completed. Send the sample to other parties via email, generate a link for faster file sharing, export the sample to the cloud, or save it on your device in the current version or with Audit Trail added.Try all the benefits of our editor right now!be ready to get more Complete this form in 5 minutes or lessGet form be ready to get more Complete this form in 5 minutes or lessGet form Step 1: Check client eligibilityLog into ProviderOne to determine if your client is eligible for the service(s) or treatment(s) you wish to provide. Learn how using our Successful eligibility checks using ProviderOne fact sheet. Note: If the client is in a managed care plan, please contact the plan for coverage and prior authorization requirements. To access other health plans, visit OneHealthPort. Step 2: Determine if a code or service requires prior authorizationUse our provider billing guides and fee schedules to review policy and find out whether a code or service requires prior authorization. National Correct Coding Initiative (NCCI)HCA's authorization services do not consider National Correct Coding Initiative (NCCI) guidelines when processing a request. Make sure your office checks the NCCI guidelines prior to submission. Important: Inadvertently approved authorizations do not guarantee claims payment. For questions about NCCI please refer to The National Correct Coding Initiative in Medicaid. How?On the Provider billing guides and fee schedules webpage:
Important: Check the code or service in the fee schedule and provider guide for where the services will be performed. You may have to check multiple schedules or guides based on place of service. For example: Check the physician fee schedule and the ambulatory surgery center (ASC) fee schedule if you are performing the service in an ASC to:
Billing guide/fee schedule quick linksThe following is a shortened list of regularly used billing guides and fee schedules.
For a complete list, visit our Provider billing guides and fee schedules webpage. Step 3: Find and complete formsAll services or items requiring prior authorization must be submitted on the General Information for Authorization (form 13-835), each individual service or item may require additional forms. View a list of all prior authorization forms on our Forms and publications webpage. Commonly used formsOne of the following forms is required to initiate the prior authorization process.
Step 4: Submit a PA requestSubmit by mail not available at this time: The agency is no longer accepting prior authorizations requests or supporting documentation by mail. Please submit by direct data entry or by fax. By direct data entry (DDE) in the ProviderOne portalProviders can direct data enter authorization requests directly into the ProviderOne System. This feature includes the ability to attach records, color photos, and x-rays. Upon successful submission, a provider will receive a 9-digit reference number; the reference number is verification that the agency has received your request. Providers must not bill or perform a procedure(s) until the agency has provided written approval. This new function does not change the way the agency processes prior authorization requests, the agency will still process requests in the order received. Please ensure that when submitting a prior authorization request that the required documentation is included along with a fax number. See the self-service training resources below:
By faxComplete the General Information for Authorization form (13-835) with all supporting documentation and fax it to: 1-866-668-1214. Note: The General Information for Authorization form (13-835) must be typed and be page 1 of your fax to avoid delays. Do not include a fax coversheet. Submit x-rays or photos (if required)Fax submissionsUse FastAttachTM services provided by Vyne Dental (formerly NEA).
There is a cost associated which will be explained by Vyne Dental. Submit supporting documentation to an existing authorizationUse one of the following cover sheets when submitting supporting documents to an already existing authorization: For example, when responding to a pend for additional information, or an existing approved authorization requires a billing code or NPI update.
For step-by-step instructions: view our guide for adding supporting documents to an existing request in pend or approve/hold status. Step 5: Check the status of an authorization or retrieve correspondenceLearn how to check authorization information in ProviderOne.
Expedited prior authorization (EPA)The EPA process is designed to eliminate the need for written requests for prior authorization for selected services/items. To view a list of qualifying services, download our EPA inventory. CriteriaFollowing certain criteria, the agency allows for use of an EPA. Criteria are explained in each of the program provider guides. Guidelines
Note: By entering an EPA number on your claim, you attest that all the EPA criteria are met and can be verified by documentation in the client's record. These services are subject to postpayment review and audit by the agency or its designee. ContactToll-free: 1-800-562-3022
Prior authorization fax line: 1-866-668-1214 |