PRIOR AUTHORIZATION APPLICATIONS

Some services covered under the Minnesota Health Care Programs (MHCP) require prior authorization. This is to safeguard against inappropriate and unnecessary use of health care services that are governed by state law and federal regulations.

The PRIOR AUTHORIZATION APPLICATIONS support the DHS prior approval process for:

  • The entry and maintenance of prior authorization requests for designated medical services, dental services, drugs, and supplies covered by any of the major programs such as Medical Assistance (MA).
  • The entry and maintenance of screening documents used for eligibility determination by the long term care (LTC) waiver programs, the developmental disabilities (DD) waiver programs and MA home care services.
  • The entry and maintenance of service agreements for recipients that are eligible for various waiver programs, Alternative Care (AC), Day Training and Habilitation (DT&H) services, special needs services, MA Home Care services and Chemical Health services.

Document being signed

 

Entry of appropriate authorization document in MMIS is necessary to authorize provider to provide services and to authorize payment of claims for these services.

 

How to access the PRIOR AUTHORIZATION APPLICATIONS

From the MMIS MAIN MENU - MAIN

  1. TAB to place cursor in front of the desired menu item.
    • PRIOR AUTHORIZATION file contains prior authorization requests for designated medical services, dental services, drugs, and supplies. Service agreements are also located in the PRIOR AUTHORIZATION file.
    • SCREENINGS file contains screening documents. In the example below SCREENINGS was selected.
  2. Type X to select desired file.
  3. TRANSMIT to advance to the next MMIS panel.
Table of MMIS MAIN MENU - MAIN 
MMIS MAIN MENU - MAIN   PROD    C101     
               ***   MEDICAID MANAGEMENT INFORMATION SYSTEM   ***               
 SEL                                     SEL                                    
    CLAIMS PROCESSING APPLICATIONS:                                             
      INQUIRY                                                                    
    REFERENCE FILE APPLICATIONS:                                                
      PROC, DRUG, DIAG, DRG, UPC                                                 
      RATES                                                                      
      TEXT                                                                       
    PRIOR AUTHORIZATION APPLICATIONS:                                           
      PRIOR AUTHORIZATION                                                        
  X   SCREENINGS                                                                 
    OTHER APPLICATIONS:                                                         
      PROVIDER FILE APPLICATION                                                  
      RECIPIENT FILE APPLICATION                                                 
      TPL BILLING APPLICATION                                                    
      FINANCIAL CONTROL                                                          
      TPL RESOURCE FILE APPLICATION                                              
      RECIPIENT MISCELLANEOUS FUNCTIONS                                          
                                                                                
                                                                                
 ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
                    S/EXT             N/EXT                    OOPS

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