5 steps to a Successful Authorization

1. Know what requires a prior authorization. Go to TexasChildrensHealthPlan.org or Navitus.com to check prior authorization requirements for Medical/Behavioral Health services before providing services or sending prescriptions to the pharmacy.
2. Become familiar with the authorization guidelines. Guidelines are available upon request and on the Texas Children’s Health Plan Provider TouCHPoint portal at TexasChildrensHealthPlan.org/for-providers.
3. Submit requests in advance of the scheduled service. Authorizations for outpatient services can take 3 business days to process. Ensuring that submissions are done in advance will avoid potential claim denials.
4. Be comprehensive in clinical documentation. Establish a protocol to consistently document data required for prior authorization in the medical record, which can help avoid delays in patient therapy, prevent potential follow-ups with patients for additional information, and minimize time spent on authorization.
5. Submit all required information. Incomplete documentation can delay the authorization process. Know what documentation is required and submit it with the authorization request.

http://www.navitus.com/texas-medicaid-star-chip/prior-authorization-forms.aspx

http://www.texaschildrenshealthplan.org/sites/default/files/pdf/Pre-Certification%20Requirements%20JULY%202017.pdf