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  Home >> Bureau of Health Services and Delivery Systems >> FAQs >> Authroizations/Referrals

  Authorizations/Referrals

 
FAQ Table of Contents

  1. If an MCO does not authorize a covered service (i.e. individual speech therapy but not group speech therapy as well), would FFS pay for the unauthorized MCO service?



  2. As an out of network provider, can I get a prior authorization from an MCO to treat their member (both Healthy Connections and Healthy Connections Kids)?



  3. Does Medicaid monitor authorization codes provided by a PCP in a MHN? How do they know if one is valid?



  4. Do contracted providers have to get prior authorization from the MCOs?



  5. What should we do if ER claims are being denied by the MCO for no authorization?



  6. How are specialty-care services handled under an MHN?



  7. Are they required to have some type of relationship (referral) with specialists in the area to assure that beneficiaries have access (i.e. the specialists accepting Medicaid patients) to services?



  8. Do Private Rehab Therapy Providers have to get a referral number from the PCP if the beneficiary is in the MHN program?



  9. Is a Private Rehab Facility who is in network with an MCO required to get authorization for therapies?



  10. Do all Medicaid covered services require authorization from the health plan?



  11. What if MCO or MHN enrollees assigned to my practice need health care my office cannot provide?



  12. Does the doctor to whom we refer a patient have to be participating with the MCO or MHN?



  13. What if we receive a request for a referral for a patient we have never seen before?



  14. What if the PCP wont give authorization because they have not seen the beneficiary or do not know them?



  15. Is PCP authorization required each time a Specialist sees an MCO or MHN enrollee?



  16. Can referrals be made by telephone?



  17. Do MCO and MHN enrollees admitted through the ER require PCP authorization?



  18. Can a PCP authorize initial and follow-up care at the same time?



  19. What happens if their physician refers a beneficiary to a specialist that does not accept their managed care plan?



  20. How should claims be filed when a PCP refers an enrollee to our office?


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