Change in Review Requirements for 3/1/08

The Maine Behavioral Health ASO Transition period ends 2/29/08.

The following are changes in ASO Review Requirements, effective 3/1/08:

1. Initial Registration Only- authorization dates and units will conform to dates and units listed in the Service Grid. Providers will not be able to request more units, or longer time periods than those in the Service Grid for Initial Registrations. Providers may request additional units via a Continued Stay Review.

2. Continued Stay Requests may be submitted no more than five (5) business days prior to the new request date for the Continued Stay Request. In other words, if the start date of the service requested in the Continued Stay Review is 2/20/08, the request may be submitted no earlier than 2/15/08.

3. If the APS Care Manager needs additional clinical information to make a determination the request will be placed into a status of HOLD for more INFO and will have a Provider Note attached to the notification download.

Providers will have up to five (5) business days to call APS Healthcare with the needed information. If the provider does not call APS Healthcare within five (5) business days, the request will be administratively denied due to lack of clinical information.

4. There is a five (5) calendar day “Grace Period” after an authorization end date in which a provider can back date a new request. If a request is submitted late there will be a lapse in covered days and a new MECMS PA Billing number will be issued.

5. If a member is only MaineCare eligible for a portion of the requested authorization period, authorized units will be pro-rated for the time that the member is eligible.

6. A clear, clinical rationale is expected with every Continued Stay Request.

7. Prior Authorization Requests must include the intake/referral information available at the time of the request.