- (1) Prior authorization (PA) is valid for the date range approved only as long as the client remains eligible for services. For example, a client may become ineligible after the PA has been granted but before the actual date of service, or a client's hospital benefit days may be used prior to the time the claim for the prior authorized service is submitted to the Division of Medical Assistance Programs (Division) for payment.
- (2) All prior authorized treatment are subject to retrospective review. If the information provided to obtain PA cannot be validated in a retrospective review, payment shall be denied or recovered.
- (3) Hospitals should develop their own internal monitoring system to determine if the admitting physician has received PA for the service from the Division.
- (4) For the Plus Benefit Package PA information refer to the PA chart in the Hospital Services Program OAR 410-125-0080.
- (5) Hospitals may also verify PA requirements by calling the Division’s Provider Services Unit or the RN Benefit Hotline (contact phone numbers are located on the Division’s website).
Statutory/Other Authority
ORS 413.042
Statutes/Other Implemented
ORS 414.065
History
DMAP 37-2011, f. 12-13-11, cert. ef. 1-1-12
DMAP 32-2010, f. 12-15-10, cert. ef. 1-1-11
OMAP 70-2004, f. 9-15-04, cert. ef. 10-1-04
HR 39-1992, f. 12-31-92, cert. ef. 1-1-93
HR 42-1991, f. & cert. ef. 10-1-91
HR 21-1990, f. & cert. ef. 7-9-90, Renumbered from 461-015-0220
AFS 72-1989, f. & cert. ef. 12-1-89
AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89