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Prior Authorization List

 

COVERED SERVICES

PRECERT

MD ORDER

 

RN CARE MANAGER

 

 

 

PERSONAL CARE

REQUIRED

 

 

HOME HEALTH CARE SERVICES IN HOME (RN, HHA, PT, OT, SLP)

REQUIRED

 

 

OUTPATIENT THERAPY (PT, OT, SLP) IN A SETTING OTHER THAN A HOME

REQUIRED

REQUIRED

 

RESPIRATORY THERAPY

REQUIRED

REQUIRED

 

NUTRITIONAL COUNSELING

REQUIRED

 

 

DME

REQUIRED

REQUIRED

 

MEDICAL SOCIAL WORK SERVICES

REQUIRED

REQUIRED

 

HOME MEALS / GROUP SETTING MEALS (AT DAYCARE)

REQUIRED

 

 

SOCIAL DAY CARE

REQUIRED

 

 

NON-EMERGENCY TRANSPORTATION

CARE MANAGER NEEDS 24-48 HOURS NOTICE

REQUIRED

 

 

PRIVATE DUTY NURSING

REQUIRED

 

 

DENTAL SERVICES

REQUIRED

 

 

PODIATRY

REQUIRED

 

 

AUDIOLOGY

REQUIRED

 

 

OPTOMETRY

REQUIRED

 

 

SOCIAL / ENVIRONMENTAL SUPPORT

REQUIRED

 

 

PERS

REQUIRED

 

 

ADULT DAY HEALTH CARE

REQUIRED

 

 

NURSING HOME CARE

REQUIRED

REQUIRED

 

CDPAS (CONSUMER DIRECTED PERSONAL ASSISTANCE)

REQUIRED