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Prior Authorization
General Information
- » ADVANTAGE Care Select providers are required to obtain
prior authorization for scheduled hospitalizations, services and/or procedures.
Emergency hospitalizations, services and procedures do not require prior authorization;
however, ADVANTAGE Care Select must be notified within 24 hours of the emergency.
- » The ADVANTAGE Health Solutions-Fee for Service and Care Select
Prior Authorization Departments review all non-pharmacy PA requests for IHCP members
(IHCP) and enrolled ADVANTAGE Care Select members.
- » Decisions to authorize, modify, or deny a given request is based
on medical reasonableness, necessity, and other criteria outlined in 405 IAC 5-3
and reflects the current standards of practice in the provider community.
- » The ADVANTAGE Fee for Service and Care Select PA departments
use the Indiana Administrative Code (IAC), PA guidelines, and IHCP bulletins, banner
pages, and newsletters.
- » Beginning July 1, 2010, ADVANTAGE Health Solutions will be authorizing
Medicaid Rehabilitation Option (MRO) services on behalf of the State. MRO services
are accessible to Medicaid members who have a qualifying MRO diagnosis and a level
of need based the Child & Adolescent Needs and Strengths Assessment (CANS) or
Adult Needs and Strengths Assessment (ANSA).
- » For a full detailed explanation of Prior Authorization processes
and procedures, please refer to the IHCP Provider Manual located at indianamedicaid.com.
Required Information for Prior Authorization
Providing complete information allows for timely processing by the Prior Authorization
Department. When requesting prior authorization the following information must be
provided:
- » Member name, ID number, and date of birth
- » Name of facility where member will receive service
- » Name of provider performing the service or procedure
- » Expected date of service
- » Service or procedure requested, including CPT/HCPCS code
- » Clinical information related to service or procedure requested,
i.e. what treatment has been tried and failed
Prior Authorization Submission by Mail:
Written requests for PA are submitted, (using an Indiana Prior Review and Authorization
Request form), to one of the following address's listed below based on the program
the member is associated to, which can be determined by the eligibility verification
obtained on the member.
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ADVANTAGE Health Solutions - FFS
Prior Authorization Department
P.O. Box 40789
Indianapolis, IN 46240
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ADVANTAGE Health Solutions -
Care Select
Prior Authorization Department
P.O. Box 80068
Indianapolis, IN 46280
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ADVANTAGE Health Solutions
MRO Prior Authorization
Prior Authorization Department
P.O. Box 40789
Indianapolis, IN 46240
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Prior Authorization Submission by Phone or Fax:
- » By Fax - Providers may fax ADVANTAGE Health Solutions - FFS and
ADVANTAGE Health Solutions - Care Select PA requests (using an Indiana Prior
Review and Authorization Request Form) to: 1-800-689-2759.
- » By Fax - Providers may fax ADVANTAGE Health Solutions - MRO Prior
Authorization requests (using an Indiana Prior Review and Authorization Request
Form) to: 1-866-541-3977.
- » Please send them on a daily basis. Please do not send large
weekly batches of PA requests!
- » By Phone - The following PA department telephone numbers are as
follows:
- ADVANTAGE - FSS & MRO: 1-800-269-5720
- ADVANTAGE - Care Select: 1-800-282-8148
- » The WebInterchange application on the IHCP website allows providers
to submit non-pharmacy PA requests and to inquire on request via WebInterchange.
- » Indiana Prior Review and Authorization Request Forms are
available at:
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