PRIOR AUTHORIZATION

Some services require prior authorization before services can be provided and claims paid. Documents created to prior authorize services are found in the PRIOR AUTHORIZATION subsystem.

After authorizations are entered into MMIS, letters to providers and recipients are generated documenting services authorized.

The PRIOR AUTHORIZATION subsystem stores medical, dental, medical supplies, pharmacy, inpatient hospital and service agreement prior authorizations.

In this course we will be learning abut service agreements in MMIS.

How to access PRIOR AUTHORIZATION file

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.
  2. Type X to select desired file. In the example below PRIOR AUTHORIZATION was selected.
  3. TRANSMIT to advance to the MMIS PA KEY 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:
X PRIOR AUTHORIZATION
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

MMIS PA KEY PANEL - AKEY

The AKEY panel is the key panel for the PRIOR AUTHORIZATION subsystem in MMIS. Field entry on the AKEY panel defines search criteria within the PRIOR AUTHORIZATION subsystem and defines what the worker wants to do.

Inquiry mode allows worker to view documents. Add mode is used to create a new service agreement. Change mode is used when worker needs to update a service agreement.

There are two styles of service agreements (SA) in the PRIOR AUTHORIZATION subsystem. Waiver (includes Alternative Care) service agreements and Home Care service agreements.

  • Waiver and Alternative Care (AC) service agreements require a screening document to be completed before the service agreement can be approved in MMIS.
  • Home Care service agreements include the assessment in the service agreement and in most cases do not require a screening document. Home Care SA has additional screens.
Table of MMIS PA KEY PANEL - AKEY
NEXT:                        MMIS PA KEY PANEL - AKEY                   

ACTION CODE: I AUTHORIZATION TYPE:
A=ADD C=CHANGE I=INQUIRY D=DENTAL P=PHARMACY
B=BATCH ENTRY D=DELETE H=INP/HOSP S=SUPPLY
M=MEDICAL
T=SVC AGMT AGMT TYPE:
1. ENTER ONE OF THE FOLLOWING KEY FORMATS:
AUTHORIZATION NUMBER: COPY FROM:
RECIPIENT ID: 00000000
PROVIDER NUMBER:

2. ADDITIONAL SEARCH CRITERIA FOR RECIPIENT OR PROVIDER SEARCH:
START DATE:
END DATE:
STATUS:
(FOR SUSPENSE RESOLUTION) LOC: USER ID:
*******************************************************************************
* AMD1 - MEDICAL PA 1 AMD2 - MEDICAL PA 2 AMD3 - MEDICAL PA 3 + *
* AIA1 - IHA PA 1 AIA2 - IHA PA 2 APH1 - PHARMACY PA 1 *
*******************************************************************************
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How to complete the AKEY panel to view service agreements

  1. Enter I (INQUIRY) in ACTION CODE field.
    • INQUIRY mode allows worker to view existing prior authorizations in MMIS.
  2. Entry of a code in the AUTHORIZATION TYPE field is optional and limits search to that type of PA.
  3. Entry of a code in the AGMT TYPE field is required when the AUTHORIZATION TYPE field is populated.
    • Entry of AUTHORIZATION TYPE and AGMT TYPE fields limits access to only the service agreement type entered.
    • In inquiry mode if no code is entered in the AUTHORIZATION TYPE field then all document types can usually be viewed for a more complete history.
    • Some security groups limit the types of documents that can be viewed.
  4. Section one requires entry of an authorization number or recipient ID. PROVIDER NUMBER field is not active for service agreements.
    • Entry of an authorization number in the AUTHORIZATION NUMBER field displays only that service agreement document.
    • Entry of PMI number in the RECIPIENT ID field is most commonly used to view service agreement history.
    • If both AUTHORIZATION NUMBER and RECIPIENT ID fields are entered MMIS posts warning message ONE KEY MUST BE VALUED - ONLY ONE KEY MAY CONTAIN A VALUE.
  5. Section 2 of the AKEY panel is optional and is used to limit search by a span or document status.
  6. In this example I (INQUIRY) is entered in the ACTION CODE field and a PMI was entered in the RECIPIENT ID field.
  7. TRANSMIT to the next MMIS screen.
    • MMIS will open the ASEL panel if more than one service agreement or prior authorization for the person exists in MMIS.
    • If only one service agreement or prior authorization document exists then the first screen of that document is displayed.
    • When no prior authorization documents meet the search criteria MMIS posts the worker message NO DOCUMENTS MEET THE SELECTION CRITERIA.

On this page we learned how to navigate the AKEY panel using inquiry mode. On the next page we will learn about navigation using add and change mode.

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