BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...

BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire June 2012
Section 8 – Behavioral Health & Alcohol and Other Drug Abuse
50
(AODA) Services
Service Areas 50
Services Requiring Prior Authorization 50
Services Not Requiring Prior Authorization 51
Section 9 – Authorization Guidelines 52
All Facility Admissions 52
Alternative Medicine Services 52
Ambulance Transportation 53
Behavioral Health & Alcohol and Other Drug Abuse (AODA) 53
Non-Emergent Surgeries and Procedures 53
Out-of-Network Referral Requests 54
Out-of-Practice-Group Referral Requests (as applicable) 54
Outpatient Care 54
Outpatient Laboratory 54
Outpatient Psychology Testing 54
Outpatient Radiology 54
Outpatient Therapies 54
Prosthetics and Durable Medical Equipment (DME) 55
Specialized Pharmacy Services 55
Section 15 – Fraud, Waste & Abuse 62
Appendix A – Health Management Forms 63
DME Authorization Request 64
Home Health Authorization Request 65
Notification for Admission Event Authorization Request 66
Out-of-Network Referral Event Authorization Request 67
Out-of-Practice Group Referral Event Authorization Request 68
PT/OT/Cardiac Rehab/Pulmonary Rehab Request 69
Service Event Authorization Request 70
Speech Therapy Request 71
Appendix B – Behavioral Health Forms 72
Autism Treatment Services Request 73
Discharge Information Request 75
Inpatient Treatment Services Request 76
Intensive In-Home Therapy Request 77
Neuro/Psychological Testing Request 79
Outpatient Treatment Services Request 80
Partial Hospitalization Treatment Services Request 81
Appendix C – County Handbook 82