Current authorization requirements for Georgia Medicaid and CMOs

I shared this info a few months ago on my linkedin site while waiting for my website to be developed again. This is an outline I share with my pediatric therapists so they can be sure to know what information I need to request authorizations for them.

Medicaid

After 8 units used for a month (an eval = 1 unit) an Auth is required.

Will need:

POC on therapist letterhead signed by md with standardized test scores every 6 months

Rx

IEP or IFSP or Attestation

Notes if child has been seen more than a month

If patient has been seen more than 1 month, will need at least 2 months’ worth of notes

Can take up to 2 weeks to hear back. Starts day that it is submitted or next day.

AmeriGroup

Eval doesn't need Auth

Will need:

POC on therapist letterhead signed by md with standardized test scores every 6 months

Rx

IEP or IFSP or Attestation

Notes if child has been seen more than a month

Hearing screen with hertz (Hearing screen is as follows: Age 0-3 can use newborn screen if passed and making progress. Over 3 need hearing screen 1x as long as making progress and passing.)

If patient has been seen more than 1 month, will need ALL months’ worth of notes

Can take up to 2 days to hear back. Starts day that it is submitted or next day.

PeachState

Eval doesn't need Auth

All other codes need Auth

Will need:

POC on therapist letterhead signed by md with standardized test scores every 6 months

Rx

IEP or IFSP or Attestation

Notes if child has been seen more than a month

If patient has been seen more than 1 month, will need at least 2 months worth of notes

Can take up to 3-5 days to hear back. Starts day that THEY DECIDE.

CareSource

Eval doesn't need Auth (unless out of network)

All other codes need Auth

Will need:

POC on therapist letterhead signed by md with standardized test scores every 6 months

Rx

IEP or IFSP or Attestation

Notes if child has been seen more than a month

If patient has been seen more than 1 month, will need at least 2 months’ worth of notes

Can take up to 2-4 days to hear back. Starts day that it is submitted or next day.

WellCare

Eval - DOES NEED AUTH, but must be obtained after Eval report is completed.

All codes need Auth

Will need:

POC on therapist letterhead signed by md with standardized test scores every 6 months

Rx

IEP or IFSP or Attestation

Notes if child has been seen more than a month

If patient has been seen more than 1 month, will need at least 2 months’ worth of notes.

Can take up to 2-4 days to hear back. Starts day that you request, can back date to last Auth expiration with reasonable time frame.

Note:

If you are waiting on a contract with a CMO to complete, you can ask for an authorization to see their member/patient while waiting. Make sure you comment this info in the comment section on mmis.georgia.gov site.

All Auths are requested through the Medicaid web portal and will find the approval there – most of the time. PeachState, CareSource and WellCare usually fax Auths when approved. AmeriGroup must be checked online only.

For CMOs – can request auth for 1 month with a written POC on therapist letterhead with test scores and Rx before POC has been from dr.

And of course, this info is subject to change...