048-40 Wyo. Code R. § 40-9

Current through April 27, 2019
Section 40-9 - Prior authorization

(a) Incorporation of Chapter 3. Prior authorization of FPRTC services shall be governed by the prior authorization requirements of Chapter 3, which are incorporated by this reference.

(b) Services which require prior authorization. All inpatient psychiatric services for individuals under age 21 furnished in a facility must be prior authorized.

(c) Failure to obtain prior authorization. The failure to obtain prior authorization shall result in the denial of Medicaid payment for the service.

(d) Submission of master treatment plan. The facility shall submit a request for prior authorization in the manner specified by the Department, including the master treatment plan, before the submission of a claim for such services. The Department may request, and the facility shall provide additional information as necessary to review the plan of care.

(e) Denial of plan of care. If a master treatment plan or any plan of care is disapproved, the provider may submit a revised plan or additional documentation within twenty calendar days of the disapproval as necessary for the Department to reconsider the plan.

(f) Reauthorization. The physician or the interdisciplinary team must review and recertify the recipient's plan of care at least every thirty days. Recertified plans of care are subject to the prior authorization provisions of this Section.

(g) Prior authorization of services furnished pursuant to a court-ordered placement. Since a reciept may be placed in a facility by a court before prior authorization can be obtained, a request for prior authorization will be considered timely if made within seven calendar days after the date of admission pursuant to a court-ordered placement.

048-40 Wyo. Code R. § 40-9