Medical Policies and Authorization Forms
OSU MHCS Prior Authorization
Effective October 15, 2008, participating physicians and participating facilities must prior authorize specified outpatient procedures and all inpatient admissions. If the physician or the facility fails to prior authorize elective inpatient or specified outpatient services, the claims will be denied. Participating facilities need to notify the Medical Management Department at OSU MHCS within 48 hours of an emergency admission. Providers need to notify OSU MHCS five (5) business days prior to a specified outpatient or elective inpatient procedure. Providers can prior authorize services by calling the Medical Management Department at (614) 292-4700.
Claims that are denied for lack of prior authorization may be reconsidered for payment, less a 20 percent penalty. This penalty will be applied to the physician and the facility. If the provider wants the claims reconsidered for payment with the 20 percent penalty, the Medical Management Department will need notes or the requested records from the provider. Providers with reconsideration requests should call the Medical Management Department (614) 292-4700.
For the list of procedures requiring prior authorization, view the "Services Requiring Medical Necessity Review List"
To view the OSU MHCS policy on prior authorization, click here.
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