Requests for prior authorization (PA) must include member name, ID#, and drug name. How you know. Navigate Medical Prior Authorization Request Form - Submit this form to request prior authorization for a medical or behavioral health service. CMS Response: April 1, 2020. If you have questions, contact the webmaster or call Medicaid Information at (801) 538-6155 or 1-800-662-9651. Please allow up to 30 days to process the hard-copy form. Theft, Personal How do you check if Medicaid is active in Georgia? Prior authorization is required for "non-emergent/urgent out of state services" as per Place of Service Review Procedures on MA Bulletin 01-06-01; 02-06-01; 14-06-01; 31-06-01; 27-06-02. CareSource will need to be contacted via phone at 1-855-202-1058 or fax at 1-844-676-0370 as there needs to be an authorization in our system that matches the billed services. Please include lab reports with requests when appropriate (e.g., Culture and Sensitivity; Hemoglobin A1C; Serum Creatinine; CD4; Hematocrit; WBC, etc.) Health care providers usually initiate the prior authorization request from your insurance company for you. Governor Kemp and the Georgia Health Care Association issued a joint statement on March 16, . Provider Services 1-866-874-0633 Attorney, Terms of When you request prior authorization for a member, we'll review it and get back to you according to the following timeframes: Title: Georgia - Inpatient Medicaid Prior Authorization Fax Form . If the form is available only in English, the link will allow you to download the form. Ordering physicians must obtain prior authorization for the following outpatient, non-emergent diagnostic imaging procedures: Ordering providers can obtain prior authorization from NIA for imaging procedures at RadMDswebsite. Via Telephone. Faxing the completed form to 1-844-490-4736 (for drugs under pharmacy benefit) or to 1-844-490-4870 (for drugs under medical benefit) Calling Provider Services at 1-800-454-3730. Step 3: Select a Specialty Designation. More Information. You can find these forms by selecting "Providers" from the navigation bar on this page, then selecting "Forms" from the "Medicare" sub-menu. To view the summary of guidelines for coverage, please select the drug or drug category from the list below. Are anesthesia services being rendered for pain management.

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