Initial Pre-Authorization:
Google Drive:
In your client’s folder, create a separate internal folder for pre-authorizations. Then, use the following templates as a guideline:
Make a copy of the templates and put the duplicate in the right folder; please DO NOT directly write in the templates.
Naming Format:
In order to keep everything consistent, please name your initial pre-auths the following way:
Last_First_Month Year_Initial Pre-Auth
Due Date:
The initial Pre-Authorization is the gateway to start services for your client with Medicaid or other insurances that require it. We want to be able to provide services as soon as possible!
If you need a supervisor to provide feedback or comments, please plan and manage your time accordingly with the due date in mind.
Initial Pre-Authorization report is due within two weeks of the evaluation date. Please send the Google Document to the Reception Team under your Google Chat with the appropriate naming format.
Insurance Info to Keep in Mind
Amerigroup
Amerigroup only compensates enough for one session per week. Your pre-authorization for number of visits should reflect that for a 6 month period. However, Amerigroup typically does not give us a hard time with approvals.
Amerigroup also approves the report typically within a day or two of the day of the report being sent - meaning they don’t read very thoroughly or they really don’t care that much.
Horizon BCBS
Horizon BCBS may approve very few sessions at a time after answering the questionnaire. Please work with the Reception Team to submit it on time, and renew before the number of sessions approved end.
After about two or three questionnaires, they will ask for a report, and you can request for the frequency that is medically necessary within a 3 month period.
Fidelis
It used to be Wellcare NJ, and the bane of everyone’s existence. It still is. The initial pre-authorization may approve 2 or 3x week sessions for a 3 month period, depending on the client’s age and severity. However, Fidelis will want to fade out services as fast, and as much as possible - especially for those with developmental disorders.
Your report really needs to demonstrate medical necessity and rationale for treatment.
Aetna
We are within-network for Aetna, meaning we don’t need to submit a report to the insurance. However, they may ask for documentation such as SOAP notes ever so often.
ANTHEM
Anthem…
Cigna
Cigna used to require a pre-auth, but they don’t really need one anymore. If it is the case that a pre-auth is required, you can request for the frequency that is medically necessary within a 6 month period.
UnitedHealthCare
UHC won’t really ask for pre-authorizations, but they will need SOAP notes every month to document progress and necessity for further treatment.
EmblemHealth
EmblemHealth…