Therapeutic Authorization Tips for Providers .


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Medicinal Authorization Tips for Providers - Overview
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Slide 1

Therapeutic Authorization Tips for Providers - Overview When An Injured Worker Presents with a Form CA-16 Services that require approval Submitting an approval ask for Information required to handle an approval Timeframes for Completion

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When An Injured Worker Presents with a Form CA-16 NO approval is required for Office Visits and Consultations Labs Hospital administrations (counting inpatient) X-beams (counting MRI and CT filter) Physical treatment Emergency administrations (counting surgery) Please DO NOT Call ACS for approvals on the off chance that you have a CA-16 – The CA-16 IS the approval

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When An Injured Worker Presents with a Form CA-16 The CA-16 DOES NOT cover Non-Emergency Surgery Elective Surgery Home Exercise Equipment, Whirlpools, or Mattresses Spa/Gym Membership Work Hardening Programs Authorization asks for must be submitted for these

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What requires approval? At whatever point you treat a DOL worker, utilize site (http://owcp.dol.acs-inc.com) to figure out whether the methodology requires approval If you don\'t have web get to, call 850-558-1818 to talk with a delegate or call the Interactive Voice Response (IVR) framework at 866-335-8319 to figure out whether approval is required Certain strategies require earlier approval – for instance surgery, non-intrusive treatment, word related treatment, and some DME.

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Authorization Levels LEVEL 1: Procedures don\'t require approval (for instance, Office Visits, MRIs, Routine Diagnostic Tests). LEVEL 2: Procedures can be approved by ACS – regularly via telephone with ACS. LEVEL 3/4: Procedures require approval by a Claims Examiner yet started by means of fax from Provider to ACS. LEVEL 5: This is secured if add up as far as possible are not surpassed and on shut cases if the date of administration is before the case conclusion date.

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How to Submit an Auth Request Online at http://owcp.dol.acs-inc.com Fax Completed Authorization Request Template to 800-215-4901 – faxes in different arrangements will be returned and not handled. Mail Authorization Request to: P.O. Box 8300 London, KY 40742-8300

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Authorization Request Templates Available in pdf organize at http://owcp.dol.acs-inc.com Click on Forms and Links Select FECA

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Info Required for Authorization Requests Claimant name Claimant case number CPT or HCPCS code(s) Specific body part to be dealt with Requested date of administration Appropriate supporting documentation Provider name and Provider Number/ID

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Info Required for Physical Therapy and Occupational Therapy Authorization Requests Claimant name Claimant Case number Requested CPT code(s) Specific body part to be dealt with Prescription from going to doctor Treatment Plan Frequency and Duration of Services Provider name and Provider Number/ID

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Info Required for DME Authorization Requests Claimant name Claimant case number CPT or HCPCS code(s) Prescription from going to doctor Duration of administrations Rental or price tag for every thing Appropriate supporting documentation Provider name and Provider Number/ID

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The case is shut The petitioner can\'t be found The date of damage is lost for inquirer with different cases We can\'t figure out what administration is being asked for Any of the accompanying are missing: Prescription, when required Rental or Purchase Price, when required Frequency and Duration Authorization Requests Will Be Returned if…

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Timeframes for Completion Within 3 business days, the approval will be in the framework, sent to cases inspector for audit, or gave back All spinal surgery and numerous other surgery approvals require District Medical Advisor (DMA) survey – expect 30 days In a few examples, extra advancement of the claim by the Claims Examiner is expected to endorse or deny an approval ask. Case unpredictability, inquirer responsiveness, Employing Agency responsiveness, Provider responsiveness, and different components affect the course of events for approval.

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Notification of Authorization Status If the approval is affirmed, the asking for supplier gets a letter via the post office. In the event that the approval can not be endorsed, the asking for supplier gets a letter via the post office. In the event that the approval can not be endorsed as of now in light of the fact that further improvement by cases inspector is required, the asking for supplier gets a letter via the post office. In the event that the approval is formally denied, the harmed laborer gets letter via the post office. Utilize http://owcp.dol.acs-inc.com to check approval status

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Further Development Letter

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Authorization Letter

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A Final Note About Authorizations… Submitting a demand does not ensure endorsement. Bills for approved administrations must meet details and necessities to be prepared and paid.

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