authorization guidelines - cardinal innovations healthcare ... · authorization guidelines page 5...

of 15 rev. 20200225

Authorization Guidelines

Adult MHSUD

Service Service Code Requirements Authorization Guidelines Funding

Assertive Community Treatment Team (ACTT) - INITIAL MEDICAID

H0040 PCP/PCP update + TAR record supporting SPMI and/or multiple hospitalizations

Initial Authorization 1 yr. (or end of PCP yr.) @ 4 units per month Medicaid

Assertive Community Treatment Team (ACTT) - Re-Authorization MEDICAID

H0040 Annual PCP + Standardized Transition Tool If clear indication that needs to remain in ACTT can request 1 yr., if indication that clinically can be transitioned authorization can be requested for time period needed avg. 90-120 for transition, with clear transition plan or detailed information why longer than this period would be required. Please refer to the UM Communication FY13-14, related to specific details

Medicaid

Assertive Community Treatment Team (ACTT)- State INITIAL

H0040 PCP/PCP update + TAR record supporting SPMI and/or multiple hospitalizations

Must have clear evidence of Medicaid application and documentation of why consumer does not qualify. Must also demonstrate a pending disability application, this should include assisting member in appealing if denied. If both these criteria are met can request for full yr. If no evidence, 60 day authorization until this has been completed. Auth 4 units per month

State

Assertive Community Treatment Team (ACTT)- State Re- Auth

H0040 Annual PCP + Standardized Transition Tool (if previously authorized for yr.) + TAR

Must have clear evidence of Medicaid application and documentation of why consumer does not qualify. Must also demonstrate a pending disability application, this should include assisting member in appealing if denied. If both these criteria are met can request for full yr. If no evidence, 60 day authorization until this has been completed. Auth 4 units per month

State

Assertive Community Treatment Team- Step Down

H0040 TS U5 PCP + Standardized Transition Tool (if previously authorized for yr.) + TAR

Authorization up to 180 days, max 2 units per month Medicaid

(b)3 Individual Support T1019: U4 Plan or PCP/PCP update if in other enhanced services, Copy of Transition Plan + TAR

Initial 90 days- Maximum of 60 hours per month For re-auth- 90 days, should show titration of units or detailed explanation as to why this cannot occur

Medicaid

b(3)- Intensive Recovery Supports Individual

T1012 U4 Plan or PCP/PCP update if in other enhanced services + TAR

Authorization 90 days, up to 160 units per month (combination of group and individual) Medicaid

b(3)- Intensive Recovery Supports Group

T1012 HQ U4 Plan or PCP/PCP update if in other enhanced services + TAR

Authorization 90 days, up to 160 units per month (combination of group and individual) Medicaid

Peer Support (Initial) H0038 Plan or PCP/PCP update if in other enhanced services + TAR + Comprehensive Clinical Assessment

6 hr. (24 unit) pass-through. Authorizations can be up to 270 units for 90 days. Can request 6 months, if requesting less than 22 hours a month

Medicaid/State


of 15 rev. 20200225

Adult MHSUD


Peer Support (Reauth without addtl treatment services)

H0038 Plan or PCP/PCP update if in other enhanced services + TAR

For members not actively linked to treatment services the guideline recommends 5 hours a month of Peer Support. Additional hours must be clinically supported inclusive of actions to ensure individual receives the clinically appropriate treatment.

Medicaid/State

Peer Support (Reauth with addtl treatment services)

H0038 Plan or PCP/PCP update if in other enhanced services + TAR + Comprehensive Clinical Assessment

Authorizations can be up to a maximum of 270 units for 90 days, however, requests should be individualized to the frequency needed for each member and based on the frequency that has been effective with the member. Requests submitted by providers requesting maximum units on all submission vs. evidence of individualized of treatment will be returned.

Medicaid/State

Peer Support Group (Initial and Sustaining Phase)

H0038: HQ U4

Plan or PCP/PCP update if in other enhanced services + TAR + Recovery Assessment Scale

5 hr. (20 unit pass through) Initial 90 days – 20 hrs./80 units per week Next 90 days – 15 hrs./60 units per week (Unit maximum are combination of group and individual). Requests can be up to 180 days with evidence of titration

Medicaid

Peer Support Group (Intermittent Support Phase)

H0038: HQ U4

Plan or PCP/PCP update if in other enhanced services + TAR + Recovery Assessment Scale

Up to 180 days- frequency not to exceed 10 hrs./40 units per wk.- requested dates cannot exceed end of plan (Unit maximum is combination of group and individual)

Medicaid

(b)3- Supported Employment Initial

H2023 HE U4 PCP/PCP Update + TAR + Employment Plan No authorization required for first 64 units. Authorization up to 180 days Max. 400 units per month

Medicaid

Clinical Assessment

No authorization required up to Max., if unmanaged sessions remain

Max. of 2 per year State/Medicaid depending on contract

Community Support Team (CST)

H2015 PCP/PCP update +TAR Authorization can be up to 128 units of service for 60 calendar days of the initial authorization period, if medically necessary. For a member actively pursuing housing, up to 420 units may be approved for the initial authorization period but the request must provide specific details related to housing status.

Medicaid/State

Community Support Team (CST)- Past 6 months

H2015 Complete new Comprehensive Clinical Assessment + PCP/PCP update including new service order

Authorization can be up to 192 units of service for 90 calendar days, if medically necessary. For a member actively pursuing housing, reauthorization may cover up to 630 units for a 90 calendar day period.

Medicaid

Group Living High YP780 CCA (at least annually) Plan + TAR + Independent Skills Assessment

Authorization every 180 days (1 unit per day) State


of 15 rev. 20200225

Adult MHSUD


Group Living High (for short term SA residential)

YP780 CCA (at least annually) Plan + TAR Initial Authorization 14 days Re-auth up to additional 14 days if medically necessary Max. 30 days per year

State

Group Living Mod YP770 CCA (at least annually) Plan + TAR + Independent Skills Assessment


Group Living Moderate (for SA residential)

YP770 CCA (at least annually) Plan + TAR Initial Authorization 30 days Re-Auth 60 days (1 unit daily) State

Group Living Low YP760 CCA (at least annually) Plan + TAR + Independent Skills Assessment


Group Living Low (for SA residential)

YP760 CCA (at least annually) Plan + TAR Authorization every 180 days (1 unit per day) State

Halfway House (SA) H2034 CCA (at least annually) Plan + TAR Authorization every 180 days (1 unit per day) State

Opioid Treatment H0020 CCA at least annually, TAR+ PCP Reviewed via UR for established provider for Medicaid. New providers- 180 day auths. All State must be pre-authorized

Medicaid State CASP (for specific programs)

Outpatient Services (individual, group, and family therapy)

TAR only when over unmanaged visit, Unless in services with therapy included then must be pre-authorized

State unmanaged 12 for child 8 for adult additional units considered on a case by case basis For Medicaid authorization needed after 24 sessions

Medicaid State

Medication Services

Unmanaged- reviewed via claims and UR

State/Medicaid

Partial Hospitalization H0035 TAR only, provider to have plan in the record Initial Auth up to 14 days, Re-auth every 14 days Medicaid

Neuropsychological Testing 96116 and 96118

No prior authorization required Reviewed via UR Medicaid/State

Psychological Testing 96101 and 96111



of 15 rev. 20200225

Adult MHSUD


Psychosocial Rehabilitation (PSR)

H2017 PCP/PCP update if in other enhanced services otherwise TAR only and provider has pcp in record

No prior auth required for programs open 5 days a wk. up to 120 units, programs open 6 days per week up to 160 units For requests exceeding those limits authorization request should be submitted. Prior authorization required for members in ACT-Step Down services

State/Medicaid

SACOT H2035 No prior Auth for first 2 months up to 20 units per wk. For Re-auth TAR + PCP

Up to 20 units per week (no prior auth for first 2 months days) Re-auth up to 60 days/ 20 units per week

Medicaid- State for Women's Specialty Programs

SAIOP H0015 No prior Auth for first month up to 12 units. For Re-auth TAR + PCP

After first month, up to 24 units for additional 2 months. Can request additional 2 week extension State/Medicaid

Supervised Living Low YP710 CCA (at least annually)+ Plan + TAR + Independent Skills Assessment + Rent Subsidy

Authorization up to 180 days, 1 unit per day State

Supervised Living Moderate YP720 CCA (at least annually)+ Plan + TAR + Independent Skills Assessment + Rent Subsidy


SA Medically Monitored Community Residential Treatment

H0013 CCA + PCP/PCP Update + TAR Initial 14 days; Concurrent 7 days up to 28 days total State / Medicaid

Supported Employment – Individual

YP630 TAR + employment plan+ At-risk checklist If in other enhanced services PCP/PCP update

NO authorization required for first 64 units. Authorization up to 180 days Max. 400 units per month

State

Medically Monitored Community Residential (ADATC)

H0013 Regional Referral Form (for Piedmont Counties) +TAR For other counties - Regional Referral Form (assigned tracking #)

For Piedmont Auth for 1 day for if have alternative funding Auth up to 14 days, re-auth up to 14 days, max 30 days from original date of service

State/Medicaid

Transition Management Services

YM120 PCP + PCP Update + TAR 5 hours pass through, request for 15 min units, up to max. of 60 units per week. Should be based on frequency needed by the member. Authorization for 90 days.

State

Reviewed February 2020


of 15 rev. 20200225

Child MHSUD


(b)3 Individual Respite H0045 U4 PCP/PCP + TAR + CCA (for initial requests) Authorization for the full plan year if the member is linked to corresponding treatment services where these are appropriate and there is a unified plan for all treatment services. Members that are not linked to treatment services will continue to be authorized six months per authorization request.

Medicaid

(b)3 Group Respite H0045 HQ U4 PCP/PCP + TAR + CCA (for initial requests) Authorization up to 6 months or up until end of pcp Max. 128 units per month (this is max of ind. And group combined)

Medicaid

(b)3 Transitional Living H2022 U4 PCP/PCP update and clinical assessment (ages 16-21) Authorization 1 unit per week for 180 days, Re-auth every 180 days Medicaid

Clinical Assessment

No authorization required up to Max. if unmanaged units remain

Max. of 2 per year State/Medicaid depending on contract

Day Treatment H2012HA PCP/PCP update including all items on checklist , and IEP/504 Plan, Behavior Intervention Plan + suspension/expulsion/incident records

Authorization 60 days (Initial + Re-Auth) Max. 30 units per week Medicaid/State

Intensive In Home Services (IIHS)

H2022 PCP/PCP update + TAR including all items on checklist, CCA for initial auth

Authorization 60 days (Initial +Re-Auth) max. 16 units per month, to be titrated over course of treatment ** For State max of 6 months for Service

Medicaid/State

MST H2033 No prior authorization. Required unless overlapping with another enhanced service. Provider must maintain CCA and PCP in the record

For Medicaid consumers reviewed via UR Medicaid/State

Medication Services

Unmanaged- reviewed via claims and UR

State/Medicaid


of 15 rev. 20200225

Child MHSUD


Outpatient Services (individual, group, family therapy)

TAR only when over unmanaged visits or when in service that includes therapy- must have prior authorization

State unmanaged 12 for child 8 for adult For Medicaid authorization needed after 24 sessions

Medicaid State For Max limits of 12 child/8 per adult, additional units considered on a case by case basis





PRTF (Initial) 911 PCP/PCP update + TAR, All items on the checklist, Psychological Assessment, CON (good for 15 days), out of state paperwork as needed

Initial authorization can be up to 30 days Medicaid

PRTF (Re-Auth Request) 911 PCP/PCP update + TAR Re-auth for up to 30 days Medicaid

Residential Level I (initial) H0046 PCP/PCP update + TAR including all items on checklist Initial auth can be up to 180 days Medicaid

Residential Level II (Initial) (S5145 (Family) + H2020 (Program))

PCP/PCP update + TAR including all items on checklist Initial auth can be up to 180 days Medicaid


of 15 rev. 20200225

Child MHSUD


Residential Level II (Re-auth)

(S5145 (Family) + H2020 (Program))

TAR only (if plan is still valid) comments should address: Progress towards each of goals; Involvement in therapy, both ind and family- if reunification is the plan and family therapy not occurring please explain Measurable step down/discharge plan, including tentative time frame for discharge

Re- Auth Can be for 60 days Medicaid

Residential Level II (Re-auth after 270 days)

(S5145 (Family) + H2020 (Program))

Pcp/pcp update + TAR justifying continuing level II, including changes to interventions and strategies being made to make service more effective, and a CCA completed in the last 30 days

Re- Auth Can be for 60 days if CCA clearly identifies why needs cannot be met with Level I or less restrictive services

Medicaid

Residential Level III-IV (Initial)

H0019 PCP/PCP update + TAR including all items on checklist, CCA completed within the last 30 days

Initial authorization can be for 30 days Medicaid

Residential Level III SAY program at Timber Ridge (initial)

H0019 Above items + a current Specific Evaluation that addresses sexual harm behaviors (within last 3-6 months) If this is a psychological done within past 30 days that address both MH, and the sexualized behaviors, this can be accepted without CCA

Initial authorization can be for 30 days Medicaid

Residential Level III- Level IV (reauth)

H0019 TAR comments should address: Progress towards goals; Measurable Step Down/discharge plan, and any active planning that is being done

Reauth can be for 60 days, until 180 days, then every 30 days Medicaid

Residential Level III- Level IV (re-auth past 180 days)

H0019 TAR+ independent psychological or psychiatric assessment and all other items noted above, individual and family therapy notes since admission, a PCP update showing changes to strategies and interventions

Re-auth can be for 30 days Medicaid

Therapeutic Leave (used for Level II, III, IV and PRTF)

183 PCP/PCP update +TAR Authorization can be requested, for same dates as the corresponding residential service, based on frequency listed in plan. Max. 15 days per quarter, 45 days per year

Medicaid


of 15 rev. 20200225

Child MHSUD


In-Home Therapy Services (IHTS)

H2022 HE U5 Assessment, CANS, + PCP/PCP Update Authorization can be for 120 days Medicaid

Family Centered Treatment (FCT)

H0036 HK U5 Assessment, CANS, + PCP/PCP Update Authorization can be for 180 days Medicaid


of 15 rev. 20200225

DD Non-Innovations


Adult Developmental Vocational Program

YP620 TAR+Plan+ Psycholaogical testing (psy testing for initial request if not already on file) + Assessment of members work ability and interests + Progress summary toward goals+ evidence of sliding scale fee eligiblity (# of people in household and household income)

Authorization up to 180 days, units are 15 minute increments not to exceed 160 units/week State

(b)3- Community Guide T2041- U4 Plan + TAR + Pyschological testing (for initial request if not already on file)

Authorization for the full plan year if the member is linked to corresponding treatment services where these are appropriate and there is a unified plan for all treatment services. Members that are not linked to treatment services will continue to be authorized six months per authorization request.

Medicaid Only

(b)3- Community Guide T2041-U1-U4 Plan + TAR + Pyschological testing (for initial request if not already on file)

Use this service code if "training" for Self-Direction/ Agency with Choice/EOR. Authorization not to exceed 30 hours or 3 months.

Medicaid Only

(b)3 - Group Respite H0045 HQ-U4 Plan + TAR + Pyschological testing (for initial request if not already on file)


Medicaid Only

(b)3 - Individual Respite H0045-U4 Plan + TAR + Pyschological testing (for initial request if not already on file)


Medicaid Only

(b)3- In-home Skill Building (High)

T2013 U4 Initial-Plan, psychological testing, preference assessment, standardized skills assessment Re-auth- TAR+ any documented changes on either assessment

1 initial unit unmanaged, Authorization up to 90 days 1 unit per week, must provide at least 4 hrs. of treatment in the week

Medicaid Only

(b)3 In-home Skill Building (Moderate)

T2013 TF-U4 TAR, plan update, changes to either of the assessments (preference or skills) Re-Auth- TAR + any documented changes on either assessment

Authorization up to 90 days 1 unit per week, must provide at least 2 hrs. of treatment in the week Medicaid Only


of 15 rev. 20200225

DD Non-Innovations


(b)3 - Supported Employment-Initial Group

H2023-HQ-U4

Plan + TAR + Pyschological testing (for initial request if not already on file)

Initial job seeking Max. 86 hrs./ 344 units per month for 180 days unless specific authorization for exceeding this limit is approved. Intermediate job support Max 43 hrs/172 units per month for the second 180 days unless specific authorization for exceeding this limit is approved.

Medicaid Only

(b)3 - Supported Employment-Initial Individual

H2023 -U4 Plan + TAR + Pyschological testing (for initial request if not already on file)

Initial job seeking Max. 86 hrs./ 344 units per month for 180 days unless specific authorization for exceeding this limit is approved Intermediate job support Max 43 hrs/172 units per month for the second 180 days unless specific authorization for exceeding this limit is approved.

Medicaid Only

(b)3 - Supported Employment-Maintenance Group

H2026-HQ-U4

Plan + TAR + Pyschological testing (for initial request if not already on file)

Long Term Support Max of 10 hrs. or 40 units per month unless specific authorization for exceeding this limit is approved, authorization not to exceed 180 days unless specific authorizaion for exceeding this limit is approved.

Medicaid Only

(b)3 - Supported Employment-Maintenance Individual

H2026-U4 Plan + TAR + Pyschological testing (for initial request in not already on file)

Long Term Support Max of 10 hrs. or 40 units per month unless specific authorization for exceeding this limit is approved, authorization not to exceed 180 days unless specific authorizaion for exceeding this limit is approved.

Medicaid Only

Group Living – High YP780 Plan + TAR + Pyschological testing (for initial request if not already on file)


Group Living – Low YP760 Plan + TAR + Pyschological testing (for initial request if not already on file)


Group Living – Moderate YP770 Plan + TAR + Pyschological testing (for initial request if not already on file)


Outpatient Services (individual, family, group therapy)

TAR only when over unmanaged visit, prior authorization required if in service that includes therapy

State max. limits 12 for child 8 for adult, additional units considered on a case by case basis For Medicaid authorization needed after 24 sessions

Medicaid/State depending on contract






of 15 rev. 20200225

DD Non-Innovations


Residential Supports YM850 Plan + TAR + Pyschological testing (for initial request if not already on file)

Authorization up to 90 days, up to 1 unit per day, units requested should be based on frequency of need for service

State

Supervised Living – 1 Res. YM811 Plan + TAR + Pyschological testing (for initial request if not already on file) + Evidence of Rent Subsidy Payment










Supervised Living – Low YP710 Plan + TAR + Pyschological testing (for initial request if not already on file) + Evidence of Rent Subsidy Payment


Supervised Living – Mod. YP720 Plan + TAR + Pyschological testing (for initial request if not already on file) + Evidence of Rent Subsidy Payment


Supported Employment – Group

YP640 Plan + TAR + Pyschological testing (for initial request if not already on file) Note this service should only be requested for members that do not have Medicaid

Authorization up to 180 days Max. 25 hrs./100 units per week State

Supported Employment – Individual

YA390 Plan + TAR + Pyschological testing (for initial request if not already on file) Note this service should only be requested for members that do not have Medicaid

Authorization up to 180 days Max. 400 units per month State

Supported Employment- Long-Term Vocational Support Services

YA389 Plan + TAR + Pyschological testing (for initial request if not already on file)

Authorization up to 180 days Max.40 units per month State


of 15 rev. 20200225

MHSADD Acute Services

Service Service Code Requirements Initial Authorization Guidelines Concurrent Authorization Guidelines Funding

LOCAL HOSPITAL: MH/SUD Inpatient

100 ICF/MR Hospital Admission / General Hospital

TAR via Provider Direct within 72 hours of admission 4 Days for MH (Voluntary OR Involuntary) 7 days for SUD

3 Days (Voluntary OR Involuntary) State/Medicaid (Funding based on Individual Provider Contracts with Cardinal Innovations)

STATE HOSPITAL: MH/SUD Inpatient

100 ICF/MR Hospital Admission / General Hospital

TAR via Provider Direct required on or before date of admission; Regional Referral Form; Diversion Form (MR/MI Only)

1 Day (Out of Catchment; Medicare / Private Ins; Private Ins), 7 Days (State / Medicaid Voluntary), 10 Days (State / Medicaid Involuntary).

N/A (Out of Catchment), 3 Days (Voluntary), UP TO 30 Days (Involuntary)

State/Medicaid

SUD Non-Hospital Medical Detoxification

H0010 TAR via Provider Direct ONLY for continued stay on or before 5th day of initial admission.

4 days pass through, Up to three days, with a max total of 20 days per episode of care with appropriate ASAM justification; one unit = one day not to exceed more than 30 days in a rolling 12-month period per member

State/Medicaid (Funding based on Individual Provider Contracts with Cardinal Innovations)

SA Medically Monitored Intensive Inpatient De-Tox

H2036 TAR via Provider Direct required on or before date of admission; Regional Referral Form

3 Days 1 Day State/Medicaid (Funding based on Individual Provider Contracts with Cardinal Innovations)

Facility Based Crisis- Child Facilities

S9484 HA TAR via Provider Direct within 72 hours of admission 7 Days (Voluntary OR Involuntary)- Can request 24 units per day

3 Days (Voluntary OR Involuntary) Medicaid

Facility Based Crisis- Adult Facilities

S9484 TAR via Provider Direct ONLY for continued stay on or before 7th day of initial admission

7 days (Voluntary OR Involuntary) 3 days max – any greater must be staffed for approval by Director of Access or designee

State/Medicaid (Funding based on Individual Provider Contracts with Cardinal Innovations)

SUD Detox Social Setting YP790 TAR via Provider Direct required on or before date of admission

3 Days / VOLUNTARY; 10 DAYS / INVOLUNTARY.

(Voluntary) 1 unit daily up to 10 days; (Involuntary) Daily

State ONLY


of 15 rev. 20200225

MHSADD Acute Services

Service Service Code Requirements Initial Authorization Guidelines Concurrent Authorization Guidelines Funding

Regular Three-Way Inpatient (MH or SUD)

YP821 TAR via Provider Direct within 72 hours of admission 4 Days = Detox, 7 Days = Inpatient. 3 Day = Detox; 3 Days = Inpatient. State ONLY (Atrium, ARMC, HRMC and Presbyterian Only)

Enhanced Three-Way Inpatient (MH or SUD)

YP822 TAR via Provider Direct within 72 hours of admission 4 Days = Detox, 7 Days = Inpatient. 3 Day = Detox; 3 Days = Inpatient. State ONLY (Presbyterian Only)


of 15 rev. 20200225

Submission Reminders

All Plans should be uploaded directly in to Provider Direct. Please refer to provider direct modules for information.

For UM Questions please email UM mailboxes:

o MHSA: [email protected]

o DD: [email protected]

o Clinical Support (MH/SUD and I/DD): [email protected]

Please submit plans when required for the initial authorization. As long as the plan has not expired and is still valid for the service being requested, plans do not need to be submitted again at the reauthorization request

unless specifically indicated on the guidelines as UM keeps these on file for reference.

When adding a new service or changing a service frequency per the PCP manual, the PCP update form must be utilized, unless a complete new Annual PCP is developed. UM is unable to accept any "changed" annual PCPs,

that were already reviewed and processed.

Plans can be submitted in word format with signatures, dates, and credentials typed in on the signature page. This indicates to UM that provider has the original signature page and could produce this upon request.

Frequency on the TAR must match plan frequency (ie units, per month, per year, etc.

TARS should be submitted at least 15 days prior to requested start date.

Please mark TARS as expedited only when there is an immediate health and safety issue that requires expedited review of the request.

UPDATE 11-19-12: Unless the service is Supported Employment and the client will lose their job without additional training hours. Clearly explain in the comments what the health and safety issues or employment issues

are.

For ALL State Service requests member must be in a valid benefit plan (target pop)

Acute Service Reminders

FACILITY BASED CRISIS SERVICES- Adult

Medicaid or State Funded

MH or SUD

Allowed 30 days per rolling calendar year from 1st admission date / cannot be provided for more than 30 days in a 12 month period.

Initial FBCS TARs are not required for up to 7 days.

Bill for up to 16 units per day.

Providers may bill up to 16 units per day for date of discharge if the member was there for 16 hrs. or more (exception: concurrency exclusions per the service definition)

mailto:[email protected]




of 15 rev. 20200225

SA H2036 Medically Monitored Intensive Inpatient (ADATC) 3 DAYS (INVOLUNTARY ONLY)

Medicaid or State Funded

Prior authorization required from date of admission

1 unit per day

When entering TAR- Service is “Diagnostic Assessment (MH/SA) – Medically Monitored Intensive Inpatient Detox (ADATC)”

Must have denials from Facility Based Crisis and other local SA de-tox programs prior to being authorized to ADATC for detox.

STATE HOSPTIAL – Service Code 100 – 10 DAYS (VOLUNTARY OR INVOLUNTARY ONLY)

Prior authorization required from date of admission.

Consumers with Medicaid should exhaust ALL other Local Medicaid options before authorizing to state hospital.

State funded consumers must have denials from all State Funded Sites prior to being authorized to a state hospital.

Consumers with Medicare and private insurance will be provided a 1-day day authorization by Cardinal Innovations to the state facility. Remainder of stay will be authorized by Medicare or private insurance company.

If Cardinal Innovations receives a state hospital authorization request for an out-of-state or out-of-catchment consumer (regardless of payor source), Cardinal Innovations will provide 1-day authorization.

Discharge Summaries may be submitted via fax prior to or day of discharge to Cardinal Innovations at 704-743-2120.

For authorization questions please contact the provider line at 855-270-3327

authorization guidelines - cardinal innovations healthcare ... · authorization guidelines page 5...

Documents