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Welcome  » March 28, 2024 11:48 PM
Program Name: BadgerCare Plus and Medicaid Handbook Area: Behavioral Treatment Benefit
03/28/2024  

Prior Authorization : Forms and Attachments

Topic #446

Attachments

In addition to the PA/RF, PA/HIAS1, or PA/DRF, a service-specific PA attachment must be submitted with each PA request. The PA attachment allows a provider to document the clinical information used to determine whether or not the standards of medical necessity are met for the requested service(s). Providers should include adequate information for ForwardHealth to make a reasonable judgment about the case.

ForwardHealth will scan each form with a barcode as it is received, which will allow greater efficiencies for processing PA requests.

Topic #19042

Behavioral Treatment Benefit

All of the following must be included as part of the PA request for behavioral treatment:

  • A completed PA/RF
  • A completed PA/BTA
  • Documentation supporting the PA approval criteria
  • A prescription for behavioral treatment from a physician or medical provider authorized to prescribe

Note: Providers are not required to submit the PA/BTA form for comprehensive services for members under the age of 6.

PA/BTA

The PA/BTA must be submitted with each PA request. The PA/BTA allows a provider to document the clinical information used to determine whether or not the standards of medical necessity are met for the requested service(s) and the proposed POC. Providers are required to ensure that the PA/BTA is correct and complete; providers may only indicate "See attached" when the form or instructions indicate that this is a valid entry. When noting "See attached," the information requested on the PA/BTA must be easily located and adequately answered in the attached information. Providers should include adequate information for ForwardHealth to make a reasonable judgment about the case. The PA request will be returned if the attached information is unclear, incomplete, or difficult for a PA reviewer to locate.

 
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