The Iowa Medicaid Enterprise will be implementing an online prior authorization (PA) system, McKesson's Clear CoverageTM, available on March 1, 2010, for certain elective outpatient high technology radiologic tests. For tests provided on or after March 1, 2010, a Prior Authorization must be obtained by the ordering provider. The ordering provider must give the PA number to the radiology provider for inclusion on the claim.
Prior authorization will not be required for procedures that occur during inpatient hospital or emergency room visits. Iowa Medicaid will identify these claims by having a place of service 21 or 23 on a CMS-1500 or the inclusion of revenue code 45X on UB04 claims indicating services were provided in the emergency room. For more detailed information about the High Technology Radiology Prior Authorization initiative please review Informational Letter No. 876.
Note on authorization turnaround time: the anticipated turnaround time for 95% of pended prior authorizations is a maximum of 10 days but typically average around 3 to 5 business days. Requests that meet the medical criteria in Clear Coverage are approved automatically in the system.
RADIOLOGY PRIOR AUTHORIZATION RESOURCES AND FORMS:
** This document is password protected. It is intended only for Iowa Medicaid providers set up to use the Clear Coverage prior authorization system. Established users can access this document by e-mailing a training manual password request to PAservices@dhs.state.ia.us; please include your Clear Coverage user name with the request. To establish an account, new users should complete a request form /sites/default/files/PriorAuth_470-4876_New.pdf.
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