Skip to Content

Prior Authorization

 

Latest Updates Services Requirements PA Documents

 

In an increasingly complex health care environment, iCare is committed to offering solutions that help health care professionals save time and serve their patients. The prior authorization process is in place to assure iCare members receive the appropriate level of care and to mitigate potential fraud, waste, and abuse.

iCare Prior Authorization

Main Content

Updates from iCare’s Prior Authorization Department

 

 

 

 

New Prior Authorization Form


The PA department has changed the Prior Authorization Request Form for DME, DMS, and Outpatient Procedures to include some critical information that will assist in the proper and accurate entry of an authorization request.

We hope these changes will make the form easier to use and will lead to better completion with less phone calls to determine incorrect or missing information. Please visit our Provider Documents page at:

https://www.icarehealthplan.org/Provider-Documents.htm to access the latest version of our Prior Authorization Request Form. 

Or click:  New Prior Auth Form to file a PA request.

 

New Prior Authorization Specific Listing


The Prior Authorization Department will be updating the Procedure Specific Listing for Q2 2021. The new Procedure Specific Listing for Q2 2020 will be effective April 1, 2021.  These new PA Specific Listings can be accessed below:


New Prior Auth Specific Listing/pdf    New Prior Auth Specific Listing/excel

An excel version of this document can be filtered by category, code, or description. The PDF can be searched using the F5 option.


The following codes are being removed from the list requiring PA effective April 1, 2021:

81244, 95700, 97760, 92604, 92626, 38221


The following codes will be added to the list requiring PA effective April 1, 2021:

G2168, G2169, 0607T, 0608T, 0596T, 0597T, 0603T, 0604T, 0613T,33741, 33745, 33746, 93241,93242,93243,93244,93245,93246,93247,93248, 92517, 92518, 92519, 92650, V2524, 33990, 33995


Those and other provider documents can be found under Provider Documents.

Please reach out to the Prior Authorization Department with questions at 1-855-839-1032 or email paassistants@icarehealthplan.org with questions.

PA Archives

For detailed procedure code specific information regarding services, procedures and devices that require prior authorization, please reference the New Prior Authorization Procedure Specific Listing. Please note that this list is updated on a quarterly basis. Please check the date on the form to ensure you are referencing the most up to date version.

Archive of Past Prior Authorization Procedure Specific Listings:

 

Personal Care Workers & PC Screening Tool

ForwardHealth requires persons who are requesting authorization for personal care (PC) service to complete and submit the Personal Care Screening Tool. Instructions and the form in both PDF and Microsoft Word format can be found on the Prior Authorization Documents page or click below for pdf versions:

Personal Care Worker fillable form

Personal Care Screening Tool

PC Screening Tool Instructions

 

Services and Procedures Requiring Prior Authorization/Utilization Management Review

Prior authorization is required for:

  • Admission to a subacute facility (Skilled Nursing Facility, Long Term Acute Care Hospital, Inpatient Rehabilitation Facility)
  • Home health care services
  • Hospice
  • Select durable medical equipment
  • Select procedures
  • Outpatient physical, occupational, and speech therapy & cardiac and pulmonary rehabilitation
  • Transplants
  • Referrals
    • For second (or addition) opinions
    • Referrals to non-participating providers outside of the member’s home state
  • For Non-Medicaid certified Providers –All Services other than Emergency Services
  • All Category III procedure codes
  • Long term care services covered under iCare’s Family Care Partnership Program also require a service authorization request from the Interdisciplinary Team.

Please note that supporting clinical documentation is required for all prior authorization requests in order to determine medical necessity. Incomplete prior authorization requests may delay processing. iCare will not retro authorize services rendered prior to the submission of a prior authorization request.

For information about Pharmacy Part D prior authorizations, coverage determinations or formulary exceptions, visit the Drug Coverage Information for Providers page.

For authorization requirements, visit the Authorization Requirements page. 

 

Should you need to file a formal complaint, please click here to Submit a CMS complaint form online 

 

H2237_IC2203_M 
Last Updated 3/1/21

Leaving iCareHealthPlan.org

By clicking this link, you may be leaving the iCareHealthPlan.org website. Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. When you select a link to an outside website, you are leaving the www.iCareHealthPlan.org website.

ProceedCancel