The Daily Dose
Prior Authorizations to Be Eliminated for 17 Care Services and Supplies
In a move designed to relieve some of the administrative burdens experienced by medical practices within our network, CDPHP is removing the requirement for prior authorization for the following services and procedures, effective January 1, 2020:
| Procedure/Service | Related Policy Number |
| Ambulatory Mental Health Programs for Adults | 1370/20.000488 |
| Diabetic Services: Equipment, Education & Shoes | 1370/20.000047 |
| Electroconvulsive (shock therapy) Therapy | 1370/20.000464 |
| Hearing Aids | 1370/20.000479 |
| Hyperbaric Oxygen Therapy (increased atmospheric pressure (oxygen) for medical therapy), | 1370/20.000203 |
| Intensive Outpatient Programs (Psychiatric), | 1370/20.0000459 |
| Intensive Outpatient Programs (Substance Use Disorder) | 1370/20.0000459 |
| Medical Nutritional Counseling | 1370/20.000472 |
| Notification of Inpatient Hospitalizations | 1550/20.000174 |
| Ostomy Supplies | 1550/20.000184 |
| Ovarian & Iliac Embolization for Pelvic Congestion Syndrome | 1370/20.000499 |
| Partial Hospitalization Programs (Psychiatric) | 1370/20.0000459 |
| Partial Hospitalization Programs/Day Rehabilitation (Substance Use Disorder) | 1370/20.000459 |
| Skin Substitutes for Wound Healing & Surgical Interventions | 1370/20.000486 |
| Stool-Based DNA Testing for Colorectal Cancer Screening (Cologuard) | 1370/20.000494 |
| Tracheostomy Care Supplies | 1550/20.000182 |
| Urological Supplies | 1550/20.000183 |
The determination was made after a careful review of claims denial history, regulatory requirements, and medical records. With this latest change in our policies, CDPHP will have removed a total of 37 prior authorizations over the last three years.
Through December 31, 2019, our providers should continue to submit prior authorization requests for all services and procedures for which they are currently required and adhere to our resource coordination policies, as services are subject to retrospective review for medical necessity. Questions about the new changes or any of our policies may be directed to our provider services department.
Adele O'Connell About the Author
Adele joined CDPHP in 2004 as an internal communications and event specialist. She then spent eight years coordinating the company’s community relations and corporate events program, in which capacity she worked with a host of non-profit organizations and co-chaired the CDPHP annual Charity of Choice campaign. Currently, she is a communications specialist and coordinator of corporate member engagement and serves on the boards of two local charities. Prior to CDPHP, Adele served as a legislative assistant for a trade association and as an acquisitions and developmental editor, specializing in educational and medical publishing. She earned a bachelor’s degree in English from Rosemont College.
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