Medicaid provides for medically necessary health services to eligible recipients for high-volume or high-dollar procedures identified by MAD, such as surgery. Prior approval is required.
Requests for prior approval can be made via telephone to Customer Service at 1-800-392-9019. Based on requirements for peer consultant review, providers will be called within 48 hours of the telephone request. Providers may also request prior approval in writing by submitting a letter with the necessary clinical documentation. These reviews are completed within six working days.
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