October 2024 Issue 

Medicare Prior Authorization list now online 

What’s not to like about the new prior authorization list for Medicare member plans that was added to the Provider Express website in September? It’s a handy reference of the behavioral health services that require prior authorization before you provide treatment to Medicare members. Check it out and see how it’ll make your Medicare billing process a breeze.  

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You now have easy access to prior authorization lists for all plans – all in one place. The Prior Authorization page on the website houses authorization lists for Medicaid, Commercial, and Individual and Family plans. Easy access to a comprehensive list of codes helps you quickly identify which services and procedures require prior authorization. You may also find more resources on this page such as ABA requirements, online submission instructions, quick links to clinical criteria and more.

For easy access, we recommend bookmarking the Prior Authorization page. You can also reach the page in two ways:

• Navigate to the Quick Links section on the homepage and click Prior Authorization, or
• Select Clinical Resources in the top navigation bar and click Services That Require Prior Authorization

Ready to submit a request?

You can use the secure portal in a 2-step process. First, log in to the portal and verify member eligibility and prior authorization requirements. Then, submit the request. A training on submitting requests online can be found here.

Please note that requirements may slightly differ by plan. Always confirm your plan’s requirements in the portal. 

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Article published October 8, 2024