Service Authorization List

Approver Initiated Service Authorization

If the Authorization Approver denies a Request for Authorization of Services but is willing to approve other services that are appropriate for the client and available, the Authorization Approver must document an Approver Initiated Authorization for Services.

• If the Authorization Approver denies a Request for Authorization of Services but will approve the other services that are appropriate for the client, they must deny all the services requested and then document an Approver Initiated Authorization for Services.
• The Approver only creates an Approver Initiated Authorization for Services if they have denied the services that were requested and the Approver has made the decision to approve alternate services.

Approver Initiated Service Authorizations

NOTE:
The information below is for Authorization Approver use only (the Authorization Approver at the BHO, OSAR or LMHA UM).
It does not apply to Provider Authorization Requesters.

Level Of Care Calculated

(Required for Authorization Approver initiated requests for services)

• This field displays the LOC calculated by CMBHS based on the information entered into the Assessment by the clinician.
• If the Assessment has not been completed at the time that the authorization is requested, the Level of Care Calculated will default as per the substance abuse or mental health services rule.
• One of the MH or SA LOC fields will display.

 

 

Level Of Care Recommended

(Required for Authorization Approver initiated requests for services)

• If the client has not been admitted to the business entity, the Level of Care Requested will default to 'None Selected' because there are no services types associated with pre-admission (the default) that require authorization.
• Pre-admission will not be a selectable service package in Level of Care Requested or Level of Care Approved.

 

 

Service Package Length

(Required for Authorization Approver initiated requests for services)

• This field reflects the length of time the service package will last.

 

Reason For Deviation

(Required for Authorization Approver initiated requests for services)

• If the LOC-R is different from the LOC-C, then a reason for the deviation must be documented.
• One of the answer choices must be selected.

Answer Choices:

• Continuity of Care per UM Guidelines
• Resource Limitations

• If there is a reason other than the answer choices above for the deviation between the calculated and clinician recommended service package, it is documented here. 

Begin Date

(Required for Authorization Approver initiated requests for services)

• Enter the begin date for the services for which you are requesting authorization.
• Enter eight numbers that represent the start date of the authorization and CMBHS will put them into the correct date format mm/dd/yyyy.

 

 

End Date

(Required for Authorization Approver initiated requests for services)

• The end date cannot be edited past the maximum time allowed for that service package. A service will be unauthorized if the date the service was delivered on a date that is past the new authorization end date.
• Enter eight numbers that represent the end date of the authorization and CMBHS will put them into the correct date format mm/dd/yyyy.

 

 

Authorization Narrative

(Required for Authorization Approver initiated requests for services)

• Because it is unusual for an Authorization Approver to initiate an authorization for services, documentation of the circumstances is required. Also required when approved units change or the first time the approved units are different from the defaulted requested units OR any health services are ("Pended" or "Denied") OR the LOC-R is different than the LOC-C)
• The authorization approver may document any relevant information related to the justification for the request, the client’s special needs or the provider’s circumstances in this text box.
• The maximum length of data characters that may be enter is unlimited.
• When all the data fields have been filled, the Authorization Approver may attach any relevant correspondence or documentation in MS Outlook email format or in MS Word format for informational purposes...
• After completion of the data entry, the Authorization Approver submits the request by CLICKING ON the Submit button.
• CMBHS sets the status of the request to “Submitted”.
• The transaction history will display a “note” of the transaction to include the date and time.
• CMBHS notifies the Authorization Requester that an Approval has been generated and waiting for review.

 

NOTE:
The information above is for Authorization Approver use only
It does not apply to Clinicians or Authorization Requesters.