You might think that using a Louisiana Medicaid waiver to pay for services is a linear process. But that’s not always the case; prior authorization (also called “prior auth”) may be required for certain services, medications, and supports. The procedure is often slow, and it can even be convoluted. But understanding how it all works can put your mind at ease.
If you want to become educated on prior authorizations for Louisiana Medicaid waivers, you’re in the right place. Read on as we cover all you need to know about prior authorizations – what they are, when they’re required, and whether you can speed up approval for services like therapy, equipment, or medications.
What is a Prior Authorization?
Prior authorization is a requirement whereby a medical provider has to get approval from a Medicaid waiver program before seeing you for an appointment, administering care, prescribing medication, etc.
There are two main goals to be aware of here:
- The provider needs to determine whether the service will be covered according to your plan of care and any reimbursement requirements in place.
- Medicaid needs to ensure that the service is medically necessary – that you really need it.
Not all Medicaid prior authorizations are approved – they may be denied for one reason or another.
How Do Prior Authorizations Work?
Wondering how the whole process goes from start to finish?
To initiate a prior auth, your medical provider (primary care provider, surgeon, or other clinical professional) will submit the appropriate paperwork to Medicaid.
After the forms have been received, a third-party data contractor will perform the prior auth review. During their review, they’ll consider several things, like:
- Recipient details
- Provider details
- Service type
- How many hours/units requested
- Intended dates of services
Medicaid handles prior auths in batches – they’re issued quarterly to providers who have requested them.
If the prior auth is approved, your provider will move forward with the requested medical care or services. If it’s denied, your service will not be covered. Typically, your medical provider will let you know of the denial and that your services won’t be covered through your Medicaid waiver.
When are Prior Authorizations Required in Louisiana Medicaid Waiver Programs?
You may wonder from time to time whether a prior authorization might be required for a given service. And the answer is that it varies based on your waiver. If a certain service is covered without a prior auth, that should be evident in your paperwork. You can look over your plan of care to browse approved services and any prior auth requirements.
Recipients can usually trust that their provider will request prior auth when necessary. But don’t hesitate to contact your support coordinator if you want to know whether a prior auth will be needed for an upcoming service or any future care.
Can You Speed Up the Prior Authorization Process?
Louisiana Medicaid prior authorizations can take upwards of 45 days from request to approval or denial. And, unfortunately, the process is largely out of your hands. You just can’t make Medicaid move faster. But you can check progress, keep documents on hand in case they’re needed, and ensure you don’t ask for something outside of your plan of care. And if your needs have changed, go to your support coordinator right away and request a plan of care update, so that the services/supports you need will be covered.
We hope you found all the information you were looking for, and we wish you the best as you learn more about the inner workings of Louisiana Medicaid.
