之前的授权

澳门真人赌场官方网站 Medical Management and 有疗效的 reviews prior authorization requests for MAP and MAP BASIC healthcare services not provided or arranged by Seton.

Seton 健康 Plan reviews prior authorization requests for the MAP and MAP BASIC healthcare services related to Seton provided or arranged healthcare services.  MAP BASIC healthcare services are provided pursuant to Seton Charity Care policies.

Prior authorization is used to assess the medical necessity of prescribed services. The majority of services do not require authorization.

Service Line Authorizations by Organization

• 澳门真人赌场官方网站 Medical Management: Authorizes certain Skilled Nursing Facility admissions as provided by CCC or 澳门真人赌场官方网站.
• 有疗效的: Authorizes customized durable equipment (ex. 轮椅, 脚趾填料, 手和手腕支架, and orthotics and prosthetics) and additional Physical Therapy services beyond standard limit (10 visits).
• 西顿健康计划: For a listing of service/CPT codes that are managed by Seton 健康 Plan (SHP) please review the MAP Prior Authorization Grid posted on SHP’s website: http://www.seton.net/health-plan/providers/reference-center/
• Note: Information regarding Non-Formulary Drug Request authorizations can be found here: http://corradopremuda.com/medical-access-program-provider/non-formulary-medication-request/

Prior Authorization Submission Process

• 澳门真人赌场官方网站 病例管理:
  • 完成 个案管理转介表格
  • Submit the completed referral form to:
    • 传真:512-978-8151
    • 在线
  • 有疗效的
    • 完成 事先授权表格
    • Fax completed authorization form and supporting documentation to 512-406-6244 or 866-272-2542 (toll-free)
  • 西顿健康计划:
    • 完成 Prior Authorization (including Polysomnography Sleep Study and Varicose Vein Referrals) form: Visit http://www.seton.net/health-plan/providers/reference-center/ 最新版本.
    • Fax completed authorization form and supporting documentation to 512-380-4253
  • Once received, the request is reviewed and authorized (approved) or denied. If approved, an authorization number is issued. A determination notice will be provided to the requestor.
    • Note: Reviewing organizations may request additional information or details to understand the nature of the request.
  • Authorization denials by 澳门真人赌场官方网站 or 有疗效的 can be appealed for reconsideration; appeals should be resubmitted to the organization that originally denied the service. Providers are encouraged to submit additional documentation justifying the requested service(s). An appeal determination communication will be provided to the requestor.
  • The Seton 健康 Plan has available peer to peer for adverse determinations. The attending provider may contact the SHP medical director that made the initial determination to discuss the services under review. The attending provider is notified within three (3) business days of the reconsideration decision.