The Department requires that all COMP services are approved prior to reimbursement being rendered. Prior approval does not guarantee reimbursement or participant eligibility. In order for an enrolled provider to be reimbursed for prior approved services, the participant must be Medicaid eligible at the time services are rendered and with a valid and current level of care determination.
802. Obtaining Prior Approval
The Regional DBHDD offices must complete a Prior Authorization Request as part of the enrollment process. The Prior Authorization must be submitted for approval to the Regional DBHDD Office. Once the prior authorization has been approved, it will be submitted to Medicaid electronically indicating the approved services, authorization periods in which services can be rendered, the provider of each service, and the procedure codes for the services. The Regional DBHDD Office will distribute to all providers listed on the prior authorization a copy of the approved PA. A copy of the prior authorization can be found in Appendix G. The enrolled provider’s COMP participant record must include a copy of the approved Prior Authorization forms. Noncompliance to this program requirement will result in a request for refund from the Department.
CHAPTER 800 PRIOR APPROVAL