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Several SNF’s have recently had issues with Medicaid denying their oxygen Prior Authorizations. After conversations with Carewise, there are a couple of main denial reasons and suggestions to correct.

The most common denial is “not returning information requested”.

•       Once the SNF faxes the prior authorization form to Carewise, they have up to 15 days to respond. Carewise’s normal response time is 5-6 days. A Lack of Information (LOI) letter is mailed to the patient address on file in kymmis. The LOI letter gives 14 days for the SNF to gather the information and get it submitted. This poses a major issue for the SNF’s that never receive the letter and do not know anything else is needed. Carewise has given a solution to this problem. The LOI letters are in Ky Health Net. Also, the SNF can call and inquire about the LOI letter. The number is 1-800-292-2392.

Another common denial is “more current MD order for oxygen”.

•       Carewise has stated that the monthly order signed by the physician every other month is sufficient for this request. Carewise has also stated that a verbal order from the physician is acceptable if the SNF notes this process was completed.

Another common denial is “provide qualifying room air oxygen saturation levels”.

•       Carewise must receive documentation for the patient’s Room Air AND Oxygen usage. Carewise will accept MARS, TARS, and Nursing Notes.