Medical Authorization Unit - Medical Unit

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Welcome to the Medical Authorization webpage. This information is designed to assist the providers with submitting prior authorization requests (PAR) correctly the first time. The goal of MAU is to streamline the PAR process while maintaining compliance with OHCA, state and federal policy and rules. Please sign on to WEB ALERTS to receive email notifications when changes are made to this web page.

NOTICE:  Effective 11/1/2016, all initial (new) PARs must be initiated using the Sooner Care Provider Portal – all PA’s sent by providers via fax or mail will be returned – see Provider Letter 2016-29 and PA Processing document for reference.


PA’s Processed by the SoonerCare Medical Authorization Unit – Medical Unit

 PA’s Processed by other SoonerCare Units and Outside Agencies and Vendors

  • Behavioral Health 1-800-522-0114 Behavioral Health
  • DDSD-Contact DDSD Area Office 1-800-349-9173
  • Dental-Contact the Dental Unit 1-800-522-0114 or Dental Prior Authorizations
  • Diabetic Supplies and Medications – 1-800-522-0114 option 4 or www.okhca.org/rx
  • Durable Medical Equipment and Supplies - Durable Medical Equipment | DMEAdmin@okhca.org
  • High Tech Imaging Services (CT, MRA, MRI and PET Scans) are processed by eviCore  - Access eviCore’s Provider Portal by using the Imaging button on the Sooner Care Provider Portal available 11/1/2016
  • Therapy Services: Occupational, Physical and Speech Therapy requests are processed by  eviCore - Access eviCore’s Provider Portal by using the Therapy button on the Sooner Care Provider Portal available 11/1/2016
  • Personal Care Services-Contact Local County DHS office
  • Waiver Programs- Call 1-800-522-0114

Resources

  • Accessing Secure Website  
  • Claim Issues-Contact Provider Services 1-800-522-0114
  • Eligibility Issues - ICF/MR PARs, Medicare as Primary, Member Name or RID Changes, Waiver Programs
  • FAQ's - Related to PA Process Change / Provider Letter 2016-29
  • Form Instructions - Forms-PAR HCA-12A and HCA13A Quick Sheet
  • General Information - Amendments, Change in Provider, Claim Issues, Fax Issues, Manual Pricing, Prescription Requirements, Retro Authorizations, Submitting Photos and Videos, Web Alerts – how to receive notifications

PA Status Explanations

PA Status
PA Explanation
Approved    
Line has met the medical necessity and been approved.
PAs are not a guarantee of payment due to a variety of
reasons such as eligibility, etc.
Denied     
Line is denied by a consultant or physician as not being
medically necessary based on the documentation submitted.
Evaluation
Line is currently waiting to be reviewed by MAU staff
Pending Line is Pending to the next level of review
Pending
Documents     
Line has been pended back to the provider who
submitted the request to obtain additional documentation -
Remarks section in the PA on the Provider Portal will indicate 
to the provider what is needed. Provider will have 10 days
to submit the requested information  
System
Cancelled     
      
Line is cancelled by the system for various reasons such as
Non Covered Services, No Eligibility, Medicare Primary, No 
Documents submitted for review, Requested Documentation
not received, etc.