Utilization Management (UM)
The (UM) Department conducts inpatient review on inpatient cases and processes Prior Authorizations/Service Requests. Participating Providers are encouraged to interact with Passport’s UM Department electronically whenever possible. Prior Authorizations/Service Requests and status checks can be easily managed electronically using the Provider Web Portal.
Managing Prior Authorizations/Service Requests electronically provides many benefits to Providers, such as:
- Easy to access 24/7 online submission and status checks
- Ensures HIPAA compliance
- Ability to receive real-time authorization status
- Ability to upload medical records
- Increased efficiencies through reduced telephonic interactions
- Reduces cost associated with fax and telephonic interactions
Passport offers the following electronic Prior Authorizations/Service Requests submission options:
- Submit requests directly to Passport by Molina Healthcare via the Provider Portal. Log in to the Provider Portal and go to Payer Space or contact your Provider Services Representative for registration and submission guidance.
- Submit requests via 278 transactions. See the EDI transaction section of our website for guidance.
Passport requires prior authorization for specified services as required by Federal and State regulations as well as the Passport Hospital or Provider Services Agreement. The list of services that require prior authorization is available, along with a more detailed list of CPT and HCPCS codes. Passport prior authorization documents are updated annually, or more frequently as appropriate. To ensure the most current information is being utilized, providers are encouraged to access the guide posted in the Frequently Used Forms section.
Requests for prior authorizations to the UM Department may be sent via the Provider Portal, telephone, fax, or mail based on the urgency of the requested service. Contact telephone numbers, fax numbers and addresses are noted in the introduction of this section. If using a different form, the prior authorization request must include the following information:
- Member demographic information (name, date of birth, Member ID number, etc.)
- Clinical information sufficient to document the Medical Necessity of the requested service
- Provider demographic information (referring Provider and referred to Provider/facility)
- Requested service/procedure, including all appropriate CPT, HCPCS, and ICD-10 codes
- Location where service will be performed
- Member diagnosis (CMS-approved diagnostic and procedure code and descriptions)
- Pertinent medical history (include treatment, diagnostic tests, examination data)
- Requested Length of stay (for inpatient requests)
- Indicate if request is for expedited or standard processing
Prior Authorization Pre-Service Review Guide
Prior Authorization Code Matrix
Prior Authorization LookUp Tool
Prior Authorization Request Form
KY Universal Prior Authorization Form
For more information, please reference the Provider Manual .
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