How to enter authorizations for PT/OT/SLP Providers on Georgia Medicaid Web Portal

I'm often asked if I have instructions on how to enter authorizations for CMOs and Medicaid for Georgia providers on the Medicaid web portal. Thought I would share how this works currently. Note - the requirements often change, so this info is as of today. Please contact me for any changes.

Medicaid web portal is used for all authorizations (CMOs and Medicaid)

mmis.georgia.gov

FIRST MAKE SURE YOU HAVE THE CORRECT DOCUMENTATION

DOCUMENTATION:

· POC must contain the following info:

Patient name, Medicaid id and DOB (matching what Medicaid has).

Letterhead of practice (containing address, phone #, provider’s name)

Location: office (11) or home (12)

Frequency: 1 or 2 x per week (for pt/ot needs time – 1 hour per week or 2 hours per week)

Diagnosis

Services: type of therapy/cpt codes

Evaluation date

POC goals

Test scores (must be within 6 months)

Therapist signature cannot be typed, nor can date be typed. If states electronic can be ok.

· Rx (not required if you have a signed POC)

· Attestation/IEP/IFSP – make sure attestation states today’s date

· Notes – must have 3 months of notes for Medicaid, 6 months’ worth of notes for CMOs (or back to the beginning date of the previous authorization). If patient is new or changed insurance companies, only use notes you have. Medicaid will require PT or OTs to have at least 1 note unless you state in the comments new patient, no notes.

· Hearing screen for AG and PSHP – can use an old hearing screen (even if performed over a year ago).

· For CMOs – you have use a POC that has not been signed by the dr AS LONG AS you have an Rx within the past 30 days.

Make sure the POC date range is written at the top of the POC. Medicaid patients - date range starting with the date the physician signed it, not the therapist’s signature. CMO patients – date range when the therapist signed

IEPs or IFSPs must have a signature page with all signatures required. IEP or IFSP signed date must match the date range of the document. If you do not have a copy of the IEP or IFSP, make sure the therapist does not mention either in their report, then attach an attestation form.

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To enter an auth:

Login to the Medicaid web portal to the provider that is requesting auth.

Look for the Prior authorizations tab, then medical review portal link from the dropdown

Click the first link under medical review portal– enter a new authorization request

Click “children intervention services”

Enter Medicaid number for whichever service the patient has (fee for service is straight Medicaid)

Check first line that the correct child’s name and dob has been populated

Contact info:

Make sure you put your name and office email, along with your contact number and fax

Request Information:

Place of service: either 11- office (for providers who do not work in BCW) and home 12- (BCW providers)

Diagnosis

Use diagnosis code off POC. Date is the date the POC was signed by the therapist. Check primary and click add

If speech therapist is asking for auth for 92526, use R63.3 for feeding as the diagnosis (can be used in addition to primary diagnosis)

Procedures

Enter the cpt codes on the line that the therapist listed on the POC. First date must start on today’s date no matter or a future date, never a previous date. Second date range should go to the end of the month when the POC ends

CMOS must be entered as date ranged based on when the POC was created/signed by therapist.

Ex (speech therapy 2x per week for a POC that was written/signed by therapist on 09/30/2019 and auth being entered online on 10/1/19):

Medicaid pts must be entered by quantity per month per code over the range of months based on when the pediatrician signed the POC.

Ex (occupational therapy 2x per week for a POC that was signed by the pediatrician on 10/27/2019 and auth being entered online on 11/1/19):

*Note when you receive an error below the cpt code entry that states “Possible duplicate of “ this could mean 3 things:

· You’ve entered an auth before for this date range but it wasn’t approved therefore the system detects it to be duplicated.

· This patient has another authorization with another provider

· You already have an authorization approved for this date range previously entered.

An easy link to count units for CMO auths: http://www.easysurf.cc/ndate2.htm

Comments/Message PATIENT SEEN (fill in blank here per POC requirements. Ex: 1 HOUR PER WEEK FOR PHYSICAL THERAPY FAMILY OF CODING.) SEE ATTACHED (per what you have to upload. Ex: IFSP/POC/EVAL/NOTES/RX) FOR FURTHER INFO.

*Also comment here if this is a new patient, especially for OT/PT.

Date admitted to program: Enter date POC signed by the therapist (should be the same as Diagnosis date above)

Description of Services Requested: Select type of therapy

Primary Care physician name: enter referring dr last name only

SCROLL TO BOTTOM OF PAGE

Click review request

Page should change and have yellow box at bottom of screen.

Click agree

Page should change again but won’t have option to upload docs yet because you need to scroll to the bottom once more.

This is your last stop for corrected the auth. You can click edit request to fix any errors you see on the page. If all is good, click Submit request

Now page will change again and have a “Create an Attachment” box that will have a button “Choose File” to allow you to upload documents listed above.

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Turnaround timeline for auths:

CMOS usually respond within 1-3 days (AG within 1 day, pshp/caresource within 4 days max, wellcare 1 day). Medicaid will show changes on the auth within 5 days but it can take up to 2 weeks.

IF you do not see a change on the web portal for CMO auth requests based on this suggested timeline, print a copy of the request off and immediately submit a new request. Sometimes CMO auth requests do not go thru the system to the CMO.