Ccp Prior Authorization Request Form

Friday, December 9th 2022. | Sample Templates

Ccp Prior Authorization Request Form – 1 Provider Handbook January 2016 Vision and Hearing Services Book Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission.

2 Table of Contents 1 Payment Window General Information for Inpatient Pre-Admission Services Guidelines for Reimbursement of Implantable Hearing Aids and Services Regarding Enrollment in School Districts, State Agencies, and Inpatient Facilities Inpatient Services, Benefits, Limitations, and Limitations for Prior Authorization and Hearing Screening Authorization Other Hearing Screening Tests Normal Audiology and Audiometry Hearing Screening Results Evaluation and Diagnostic Services Otologic Examination Documentation Prior Authorization Limitations Documentation Requirements Claim Filing and Reimbursement Non-Implantable Hearing Aid Claims Reimbursement Third Party Liability National Correct Coding Initiative (NCCI Medical Initiative) MUE) Guide to Hearing Aids and Registered Services Registration Services, Benefits, Limitations and Prior Authorization Cochlear Implants Prior Authorization Limits Auditory Rehabilitation ABIHORIDING Audi auditory tory auditory auditory auditory auditory Impraiting (Baha)

Ccp Prior Authorization Request Form

Ccp Prior Authorization Request Form

3 Advance Authorization Limitations Sound Processor Replacement and Repair Advance Authorization Limitations Bone Conduction Electromagnetic Hearing Aids – Remove Only Documentation Requirements Filing Claims and Refunds Filing and Refund Claims, Third Party Liability Reimbursement, Visual Provision of Federal Qualifications and Guidelines for MUE Qualifications Made in Authorization Services Long-Term Care Facilities Health Care Center (FQHC) Services THSteps Medical Screening Vision Tests THSteps Preventive Care Outpatient Medical Screening Medical Screening E Services Not Covered Vision Testing Medicines Nee Exams General Tests Ophthalmic Anesthesia Corneal Topography Sensorimotor Exams or Otoscopy Exams Orthoscopic Angioscopy or angiography Other professional services Vision services Prosthetic glasses and frames Requirements for contact lenses and corneal dressings for dispensing (Medicare Replacement Repair Coverage for non-prosthetic glasses vision services for other prosthetic glasses temporary spectacle prostheses or contact lenses contact) Requirements for documentation of protective surgical services.

Molina Prior Authorization Pdf Form

4 4.5 Filing Claims and Reimbursement Claims Reimbursement Guidelines NCCI and MUE Claims Resources Contact Form TMHP Sample Claim Form

5 1 General information The information in this manual is intended for optometrists (doctors of optometry), ophthalmologists and opticians who provide eye and vision services, and hearing aid professionals (fitters and dispensers, doctors and audiologists) who provide audiologists. assessment or fitting and delivery services. The handbook provides information about Texas Medicaid benefits, policies and procedures that apply to these providers. Important: All providers must read and comply with subsection 4.1, Registration. It is a violation of Texas Medicaid regulations if a provider fails to provide services or medical items to Medicaid clients in accordance with the standards and criteria accepted by medical associations that govern their profession, including compliance with all mandatory requirements for Texas Medicaid. Pursuant to Title 1 of the Texas Administrative Code (TAC), in addition to being subject to penalties for failure to comply with specific Texas Medicaid requirements, providers may also be subject to Texas Medicaid penalties for failure to maintain, at all times, without retention. limitations, all applicable licenses to provide health care, documentation and record maintenance and items and services to Medicaid clients in full compliance with certification requirements. See: Section 1: Provider Registration and Liability (Vol. 1, General Information). This handbook contains information about Texas Medicaid fee-for-service benefits. For information about managed care benefits, see the Medicaid Managed Care Handbook (Vol.2, Provider Handbook). Managed care services are administered as fee-for-service benefits. A list of all deductible services is available in Section 8, Covered Services, of the Medicaid Managed Care Handbook (Vol. 2, Provider Handbook). 1.1 Reimbursement Guidelines for Preadmission Inpatient Services Under the three-day and one-day reimbursement guidelines, most professional and outpatient diagnostic and non-diagnostic services are provided during a specified inpatient period. not reimbursed separately from inpatient hospitalization. inpatient hospital stay admissions If the services are provided by a hospital or an organization wholly owned or operated by the hospital. These reimbursement guidelines do not apply in the following situations: Professional services are provided in an inpatient hospital setting. Both the hospital and the doctor’s office or other organization are a third party, such as a health system. The hospital is not the sole or 100 percent owner of the company. For more information on payment window reimbursement guidelines, see the section, Payment Window Reimbursement Guidelines, in the Hospital Inpatient and Outpatient Services Manual (Vol. 2, Provider Manual). 5

6 2 Non-implantable hearing aids and related services 2.1 To enroll in Texas Medicaid, hearing care professionals (physicians, audiologists, and hearing aid manufacturers and dispensers) who provide hearing evaluation or fitting and distribution services must be licensed by The Licensing Board. Practice the profession in the State where the service is performed. Hearing aid providers are eligible to register as individuals and establishments. Audiologists are eligible to register as individuals and groups. Audiologists may register as audiologists and as hearing aid manufacturers and distributors by completing the registration application for each provider type (ie, select audiologist on one application and hearing aid on the other application). Providers cannot register if their license expires within 30 days. Current licenses must be submitted to school districts, state agencies, and inpatient facilities seeking reimbursement for audiology and audiometry evaluations and diagnostic services for suspected and confirmed hearing loss (reimbursable to providers of school health and related services [ SHARS] other than audiology evaluation and therapy services). Providers [SHARS]), school districts, state agency audiologists and inpatient hospitals employed or contracted must register as individual practitioners or group practitioners when selecting audiologists on the registration application. For hearing aid devices and accessories and visits and re-examinations, audiologists and hearing aid manufacturers and dispensers must reimburse individual practices or facilities for hearing aid selection by school districts, state agencies and inpatient hospitals. are employed or contracted. On the registration application. Appropriately licensed providers who wish to provide both audiology services and hearing aid fitting and dispensing services must complete an application for an audiologist and hearing aid fitter and dispenser for each program in which they wish to enroll. Note: SHARS cannot use the Texas Provider Identifier (TPI) to bill for these services. 2.2 SERVICES, BENEFITS, LIMITATIONS AND PRIOR AUTHORIZATION Texas Medicaid hearing services benefits include medically necessary services for individuals of any age with suspected or diagnosed hearing loss that can be improved or improved by the use of a hearing aid. These services may be reimbursed to audiologists or hearing aid manufacturers and dispensers. Note: Medically necessary hearing services are not considered part of the Texas Medicaid hearing services benefit. Providers may refer to other Texas Medicaid Provider Procedures Manuals for information on benefits and limitations on other hearing-related services. Texas Medicaid clients of any age are eligible to receive hearing aids and medically necessary services through the hearing services benefits described in the following sections. Texas Medicaid hearing services benefits include a wide range of hearing services for clients of all ages and reimburse Texas Medicaid-registered providers accordingly based on their license and scope of practice. Prior authorization is not required for benefits within program limits unless specifically noted in the sections below. 6

7 The following hearing services are Texas Medicaid benefits for audiologists, hearing aid manufacturers and dispensaries, and physicians as prescribed by their licensure, scope of practice, and registration: Audiologists and physicians may be reimbursed for evaluations audiology and audiometry and diagnostic services for suspected and confirmed hearing loss. Fitters and hearing aid providers may be reimbursed for hearing aid devices and accessories and for visits and re-visits. Physicians may be reimbursed for otology and otorhinolaryngology (ENT) services. Texas Medicaid clients who have a hearing aid or appear to be occupationally capable and work requiring a hearing aid can refer hearing aid restrictions and all required forms to the Texas Department of Assistive and Rehabilitation Services (DARS). Offered to Texas Medicaid clients must be medically necessary. Unless otherwise specified, services may be reimbursed without prior approval within prescribed limits. In addition to services that still require prior authorization, providers may require prior authorization for medically necessary services that exceed benefit limits. The required forms mentioned in the specific sections below do not need to be submitted with the claim, but the forms must be completed and retained by the client.

Driscoll Prior Authorization Form

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