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Medicaid Ancillary PAs: Due May 1, 2022

In the last issue of KAHCF Connections, the association announced that effective May 1, 2022, all FFS and MCOs may require a Prior Authorization (PA) for Skilled Nursing Facility providers. The association issued the announcement after receiving a Provider Letter notice dated March 16, 2022. (See link below.)

In a Billing Work Group meeting this morning, Carewise Peer Review Organization (PRO) representative Tracy Treat provided information to the Work Group that will help in the transition. Effective May 1, 2022, nursing facilities will again be required to obtain a PA for ancillary services, and to assist facilities with this activity, the PRO will follow the steps below to ensure a smooth transition:

For residents receiving Physical, Occupational, and Speech Therapy, please follow the steps below:

•    Therapy plan of care that begins prior to but spans May 1st, submit the following documents to obtain Prior Authorization for your plan of care dates
•    Therapy plan of care begins May 1st

For residents needing Oxygen authorizations, the following outlines the process to be followed:

•    Please complete the spreadsheet (link below) for any resident in your facility that is receiving oxygen and email back to PRO at the following email address: Ronda.Phillips@Carewisehealth.com
•    Facilities will be required to submit all requests via fax once the spreadsheet has been submitted back to PRO

Should providers have any questions regarding the process mentioned above, please email Tracy Treat at tracyjo.treat@carewisehealth.com or call Carewise at (800) 292-2392.

Click here to view the Provider Letter notice dated March 16, 2022.

Click here to view the Oxygen Authorization Spreadsheet.

If you need assistance, please contact our office. Call us at (270) 726-4033.

Sarah McIntosh, President