Apple Health (Medicaid) Provider Alert
What changed?
Effective January 1, 2020 payment for inpatient hospital facility fees for dental surgeries became the responsibility of the Apple Health client’s managed care organizations (MCO).
What is the issue?
The utilization review/management of the service remains the responsibility of the Health Care Authority (HCA). This leaves a challenge for the MCOs to know if a service has been authorized as they do not have direct access to this information.
How do I avoid denials?
To avoid denials, do the following when a prior authorization is required or when using an expedited prior authorization (EPA) as appropriate:
- Provide a copy of HCA’s approval letter with your billing to the MCO.
- Enter the prior authorization number or EPA number on your billing to the MCO.
Some MCOs may contact you requesting that you call to inform them of the prior authorization/EPA in advance.
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