Prior Authorization Errors
Please be advised effective April 1, 2013, Oklahoma Health Care Authority rules regarding prior authorization (PA) requests will change. These changes have already begun affecting the process and procedures here at AAU. This change includes the AAU receiving notification of PA errors by the OHCA. Effective immediately, when a PA error is identified, a member of the AAU team will notify the proper provider of the error and advise what needs to occur to resolve the error. The following is a list of error codes identifying the majority of issues we are seeing at this time:
- Code 45 – PA units billed is greater than units authorized
- Code 46 – the service end date was prior to the date of service
- Code 58 – duplicate service authorized on PA number
To assist our providers, and to alleviate billing issues, it is imperative to have your agency work in cohesion with the AAU when the requests for action is made to your provider agency requesting assistance in resolving a PA error. We are requesting the provider act immediately (within 1 working day), to resolve the error. At this time no action can be made on a member’s case until the PA issues are resolved.
If the PA error is due to billing after the service end date, the AAU will be contacting the Case Manager requesting documentation, to include justification identifying the provider was notified timely of the service ending, including the date of the notification. In addition, it is imperative that the Case Manager act immediately (within 1 working day) to submit this info to AAU, to allow the PA error to be addressed appropriately and timely. If the Case Manager did not notify the provider of the service ending or cannot provide documentation supporting this, further communication will occur with the Case Manager/Agency, due to the negative financial impact on the provider(s).
We appreciate your patience, understanding, and prompt responses while we work through this process change.
If you have any questions about this OHCA change, please review the Global Message titled “Prior Authorization Requests” dated 2/19/2013 on the OHCA Website. (link opens in new window)
If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail at firstname.lastname@example.org.