405 IAC 5-3-2 - Prior authorization by telephone

Current through March 30, 2022

Authority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-21-3

Affected: IC 12-15-30-1

Sec. 2.

(a) Prior authorization for selected services is available by telephone when the request is initiated by a provider authorized to request prior authorization as listed in section 10 of this rule. A prior authorization request form is not necessary for these selected services. Additional written substantiation and documentation may be required by the office. Notification of approval or denial will be given at the time the telephone call is made for the following:
(1) Inpatient hospital admission and concurrent review, when required under this rule.
(2) Continuation of emergency treatment for those conditions listed in section 13 of this rule on an inpatient basis originally without prior authorization subject to retrospective medical necessity review.
(b) Prior authorization may be obtained by telephone provided a properly completed prior authorization request form is subsequently submitted for the following:
(1) Medically necessary services or supplies to facilitate discharge from or prevent admission to a general hospital.
(2) Equipment repairs necessary for life support or safe mobility of the patient.
(3) Services when a delay of beginning the services could reasonably be expected to result in a serious deterioration of the patient's medical condition.

Notes

405 IAC 5-3-2
Office of the Secretary of Family and Social Services; 405 IAC 5-3-2; filed Jul 25, 1997, 4:00 p.m.: 20 IR 3303; filed Sep 27, 1999, 8:55 a.m.: 23 IR 308; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA Errata filed 11/1/2016, 9:36 a.m.: 20161109-IR-405160493ACA

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