A Message from iCare’s Prior Authorization Department
New Prior Authorization Form
The PA department is changing 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 newest version of our Prior Authorization Request Form.
Or click: New Prior Auth Form to file a PA request.
We will no longer be accepting older versions of the Prior Authorization Form after March 6th, 2020.
New Prior Authorization Specific Listing
The Prior Authorization Department is releasing the Procedure Specific Listing for Q1 2020. This listing was placed on the website February 5th, 2020 for providers to consult. The Procedure Specific Listing for Q1 2020 will be effective March 6, 2020 and can be accessed at the link below:
https://www.icarehealthplan.org/Prior-Authorization.htm or by clicking
New Prior Auth Specific Listing/pdf New Prior Auth Specific Listing/excel
Providers and staff will notice that the Prior Authorization Specific Listing for Q1 2020 looks significantly different than previous listings. We have changed the formatting to make it more searchable and user friendly. An excel version of this document is included, which will be able to be filtered by category, code, or description. The PDF can be searched using the F5 option.
The following codes are being retired effective March 6, 2020:
0249T, 0340T, 0341T, 0357T, 0359T, 0360T, 0361T, 0363T, 0364T, 0365T, 0366T, 0367T, 0368T, 0369T, 0370T, 0372T, 0374T, 0375T, 0377T, 0380T, 0399T, 0406T, 0407T, 19304, 81211, 81213, 81214, V5170, V5180, V5210, V5220, G0163, 36469, 90911, 97532, 64508, 64402, 64410, 64413, L7260, L7261
The following codes will be requiring Prior Authorization effective March 6, 2020:
0563T, 0564T, 0565T, 0566T, 0567T, 0568T, 0569T, 0570T, 0571T, 0572T, 0573T, 0574T, 0575T, 0576T, 0577T, 0578T, 0579T, 0581T, 0582T, 0583T, 0584T, 0585T, 0586T, 0587T, 0588T, 0589T, 0590T, 0591T, 0592T, 0593T, 99458, L2006, L8033, 90912, 95700, 0155U, 0156U, 0158U, 0159U, 0160U, 0161U, 0162U, 81277, 81307, 81308, 81309, 81522, 81542, 81552, 64451, 64454, 64624, 64625, 66987
Please reach out to the Prior Authorization Department with questions at 1-855-839-1032.