Tag: Prior auth

MADISON, Wis. – MAMES requests examples from Michigan-based providers on situations were a prior authorization submitted for a traditionally non-covered item required more information, causing delays in patient access. As of Aug. 1, 2020, Wisconsin Medicaid removed the list of non-covered items from the DME service area of the Online Handbook in accordance with a federal statute. Since then, the MAMES Insurance Committee has been working on issues related to this change and...

With CMS launching a new mandatory prior authorization program for group 2 support surfaces in July, suppliers are understandably concerned about accommodating patients with immediate needs for pressure support, particularly upon hospital discharge.Discharge planners typically start care coordination when the doctor signs the order to go home. Suppliers point out that the authorization process takes time. Suppliers must gather supporting documentation from multiple sources, and contractors will scrutinize...

WASHINGTON - HME providers can breath a little easier when it comes to CMS's proposed time frame for responding to prior authorization requests, says AAHomecare. Originally, the agency said responses to prior authorization request would be issued within 10 business days, or two days for expedited requests. AAHomecare argued that the responses need to be completed within 24 hours, or two hours for expedited requests, to meet patient needs.Fortunately, CMS has now said it will not finalize its original...