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016.06.36-261.110. Post-Procedural Authorization Process for Beneficiaries Under Age 21 8-1-21

AR ADC 016.06.36-261.110Arkansas Administrative CodeEffective: August 1, 2021

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 36. Physician/Independent Lab/Crna/Radiation Therapy Center Provider Manual (Refs & Annos)
Section 260.000. Prior Authorization.
Effective: August 1, 2021
Ark. Admin. Code 016.06.36-261.110
016.06.36-261.110. Post-Procedural Authorization Process for Beneficiaries Under Age 21 8-1-21
Currentness
A. Providers performing surgical procedures that require prior authorization are allowed 60 days from the date of service to obtain a PA if the beneficiary is under age twenty-one (21).
B. The following post-procedural authorization process must be followed when requesting an authorization for the procedures in Section 262.000.
1. If requested by phone the call must be made by a physician or a physician's office nurse and will be recorded.
2. If the provider receives only the Medicaid identification number from the beneficiary and is unable to obtain the actual card to validate the eligibility dates, the information may be obtained by calling the Provider Assistance Center. View or print the contact information for provider assistance.
3. Consulting physicians are responsible for contacting DHS or its designated vendor to have their required or restricted procedures added to the PA file. They will be given the prior authorization on cases that are approved. A letter verifying the PA will be sent to the consultant upon request. All patient identification information and medical information related to the necessity of the procedure requiring authorization must be provided.
C. Providers must obtain prior authorization for procedures requiring approval in order to prevent risk of denial due to lack of medical necessity.
This policy applies only to those eligible Medicaid beneficiaries under age twenty-one (21). This policy does not alter policy currently applicable to retroactive-eligible beneficiaries.

Credits

Eff. Oct. 1, 2006. Amended Aug. 1, 2021.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.36-261.110, AR ADC 016.06.36-261.110
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