Prior Authorization : Submission Options

Prior Authorization Collaboratives

A PA collaborative will link two or more PA requests for the same member together so providers can easily see and maintain them.

Any of the following provider types may initiate or add a PA request to a collaborative:

• Physical therapists
• Occupational therapists
• Speech-language pathologists
• Home health agencies
• Personal care agencies

A provider can indicate their PA request is part of a PA collaborative when submitting their request through the ForwardHealth Portal.

Submissions to PA Collaboratives on the Portal

Providers can submit a PA request as part of a new or existing collaborative on the Portal. The Portal will then assign a nine-digit ID number that the initiating provider can share with collaborating providers. The collaborating providers will use the collaborative ID number to associate their own PA request with the collaborative.

PA collaboratives are available for the following process types for PA requests submitted through the Portal:

• 111–PT
• 112–OT
• 113–SLP
• 114–SOI for PT
• 115–SOI for OT
• 116–SOI for SLP
• 120–Home care
• 120–Home health therapy
• 121–Personal care services

Note: Providers that select process type 120 for private duty nursing or process type 142 for behavioral treatment should select None in the Provider Collaboration section of the Initial Information panel when submitting their PA requests through the Portal. If a provider selects New Collaborative or Existing Collaborative in the Provider Collaboration section of the Initial Information panel, ForwardHealth will return the PA request to the provider to resubmit.

After successfully submitting a PA request to a PA collaborative, providers can view all PA requests within it. Through the PA Collaboration panel on the Portal, providers have the option to attest that the PA should remain in the collaborative or they may choose to opt out of the collaborative.

PA requests and amendments will continue to be reviewed individually, regardless of whether they are part of a PA collaborative or not. The denial or modification of one PA request will not impact other PA requests in the same collaborative.

Providers can remove their own PA requests without ending the collaborative if two or more PA requests remain in the collaborative.

All PA requests in a PA collaborative must have start and end dates within the date range of the PA collaborative. If only one PA request remains in the collaborative, the provider must opt out of the collaborative to submit their PA request independently, unless another PA request is added. Providers should refer to the ForwardHealth Provider Portal Prior Authorization User Guide for step-by-step instructions on navigating the Portal for PA collaboratives.

If a provider submits a PA request to be added to an existing PA collaborative, but the collaborative has already been submitted through the Portal, then the provider will get the following message displayed on their screen:

"The Collaborative ID has been submitted and additional PAs may not be added in the WIPortal. Please use the PA Amendment Process to have the PA added to the PA Collaborative ID."

Real-Time Review and Approval Not Available for PA Collaboratives

Certain PT, OT, and SLP, and personal care services are able to access real-time PA review. At this time, the real-time PA review is not available for PA collaboratives or the PAs they contain.