Medicaid Management Information Systems Maine Integrated Health Management Solution

7.Authorization Confirmation

Upon the successful submission of the prior authorization, an authorization confirmation screen will be populated. This screen provides the user with an authorization number, the ability to view appeal rights, and a summary of the prior authorization request as seen in Figure 7-1: Confirmation Page.

1. 
   By using the buttons at the bottom of the screen, you may print the authorization confirmation, add attachments, or print an attachment cover sheet, if necessary. See
   
   1. 
      Section 8: Add Attachment to Prior Authorization,
      
   2. 
      Section 9: Prior Authorization Cover Sheet, and
      
   3. 
      Section 10: View Authorization Status
      

Figure 7 17: Confirmation Page

2. 
   Click on the View Appeal Rights hyperlink located in the Authorization Information in Figure 7-1: Confirmation Page to open an explanation of the rights for appeal as shown in Figure 7-2: View Appeal Rights.
   

Figure 7 18: View Appeal Rights

8.Add Attachments to Prior Authorization

• 
  Letter of Medical Necessity
  
• 
  McKesson Criteria Sheets
  

1. 
   Select the Add Attachment button at the bottom of the confirmation screen, as shown in Figure 7-1: Confirmation Page.
   
2. 
   The Add Attachments screen will open in a new window as shown in Figure 8-1: Add Attachments. Authorization information is pre-populated on the top of the page.
   
3. 
   Click the drop-down menu to select the Type of Attachment that will be added. This field defaults to PA Support.
   
4. 
   Select the Browse button to locate the file on your local computer. All supporting document files must be in one of these formats:
   

• 
  GIF
  
• 
  JPEG
  
• 
  MS Excel (.xls)
  
• 
  MS Word (.doc)
  
• 
  PDF
  
• 
  TIFF
  

5. 
   Click the Attach button when the selected file to upload is listed in the Browse field.
   

6. 
   Each attachment must have a unique filename.
   
7. 
   Once you have received a message that your attachment has been successfully submitted the user may:
   

1. 
   Repeat Steps 1 through 6 to attach another document.
   
2. 
   Click the Cancel button to return to the Authorization Confirmation screen.
   

Figure 8-1: Add Attachment

9.Prior Authorization Cover Sheet

If you need to mail in or fax the attachments, use the steps below to print a Prior Authorization Cover Sheet:

1. 
   Click the Print Attachment Cover Sheet button located at the bottom of the confirmation screen.
   
2. 
   A new window will populate with the Prior Authorization Cover Sheet, as shown in Figure 9-1: Prior Authorization Cover Sheet, which must be included as part of the manual submission of any attachments.
   
3. 
   Select the Print button located at the bottom of the screen to print the Prior Authorization Cover Sheet as shown in Figure 9-1: Prior Authorization Cover Sheet.
   

Figure 9-1: Prior Authorization Cover Sheet

4. 
   Send this cover sheet, along with any attachments, via fax or mail to:
   

Prior Authorization Unit

Office of MaineCare Services

11 State House Station

Augusta, ME 04333-0011
Fax #: 1-866-598-3963

10.View Authorization Status

1. 
   On the left navigation pane, locate the Authorization Status link under Form Entry to access the View Authorizations screen. See Figure 10-1: Form Entry- Authorization Status.
   

Figure 10 19: Form Entry-Authorization Status

2. As shown in Figure 10-3: Authorization Status, this screen provides a list of the most current prior authorization requests submitted by a specified billing provider.

3. The Billing Provider selection reflects data associated with the trading partner logged into the online portal and requesting the authorization status.

1. 
   A different Billing Provider can be selected from the Billing Provider drop-down menu only if the Trading Partner has additional provider associations. This action will bring up a list of the most current prior authorizations submitted for that provider.
   

4. 
   The prior authorization list for the specified provider is automatically sorted by the date of service in the order of newest to the oldest.
   
   1. 
      The Authorization Search screen will display, as shown in Figure 10-2: Authorization Search.
      
   2. 
      Enter the authorization search criteria into the authorization tab and click the Search button.
      

3. 
   The search results will populate at the bottom of the authorization search screen, as shown in Figure 10-3: Authorization Status.
   

Figure 10 20: Authorization Search

Figure 10 21: Authorization Status

4. 
   To view the authorization detail, click the Auth # next to the appropriate authorization. This displays the authorization details screen as shown in Figure 10-4: View Authorization Detail. This screen displays the options shown in Table 4: View Authorization Detail Functions.
   

4. 
   The disposition of a Prior Authorization request may be any of the following codes, as shown in Table 5: Prior Authorization Disposition Codes:
   

Figure 10 22: View Authorization Detail

At times, the users search may not display a PA. Some reasons a PA would not display are:

• 
  Searching for a specific member
  
• 
  Searching for a specific date range.