Remittance Advice Alerts/PROMISe Banner Pages
Subject: Reminder for Prescribers and Providers to Verify by Procedure Code Whether Prior Authorization is Required for a Service, Including a Laboratory Service
Banner Date: September 14, 2018 through October 16, 2018
Cycles: 12, 13, 14, 15 and 16
Provider Type: All

Subject: Reminder for Prescribers and Providers to Verify by Procedure Code Whether Prior Authorization is Required for a Service, Including a Laboratory Service
 
The Department of Human Services is issuing this Remittance Advice Banner to remind prescribers and providers that certain services, including laboratory services, require Prior Authorization (PA). Prescribers and providers are responsible for using the online Medical Assistance (MA) Program Fee Schedule to verify whether a service (procedure code) requires PA.
 
Prescribers and providers should view the MA Program Fee Schedule by accessing the following website link:
 
Prescribers and providers must review the OMAP – Outpatient Fee - User Agreement, located in the above link; agree to the terms and conditions in the agreement by selecting “I Accept” at the bottom of the webpage. Prescribers and providers are to enter the procedure code, select “Start Search”, then select the “Details” and “Limits” links. On the “Limits” webpage, the PA indicator is listed under the column designated as “PA” next to the Health Care Benefit (HCB) number. Refer to the “PA Indicator Key” to determine whether the service (procedure code) requires PA.
 
Please refer all questions to the provider inquiry line.
 
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