Together with CCHP contracted providers are responsible for obtaining prior authorization before they provide services to covered members.
- Effective January 1, 2019, your office may need to submit prior authorization requests for medications differently for Together with CCHP, depending on if the drug falls to the medical benefit or the pharmacy benefit. Please be sure to read these instructions.
- Prior Authorization List:
These new skin substitute codes have been added to the prior authorization list: Q4183; Q4184; Q4185; Q4186; Q4187; Q4188; Q4189; Q4190; Q4191; Q4192; Q4193; Q4194; Q4195; Q4196; Q4197; Q4198; Q4200; Q4201; Q4202; Q4203; and Q4204.This is effective March 1, 2019.
These Diabetic and Neuropathy Procedure Codes for DME and Foot Care, A5513 and A5514, have been added to the prior authorization list. This is effective March 1, 2019.
These DME codes have been added to the prior authorization list: E0447, E0467 and L8698. Prior authorization is required if the purchase price or the monthly rental price is greater than $500. This is effective March 1, 2019.
- No Prior Authorization List:
The following codes have been added to the no prior authorization required list: A9589; B4105; C9407; C9754; C9755; G2011; and J0841.This is effective March 1, 2019.
- Non-covered List:
These codes were added to the non-covered list: A4563; C1823; C1890; C8937; C9751; C9752; C9753; L8701; L8702; J3591; G0068; G0069; G0070; G0071; G0076; G0077; G0078; G0079; G0080; G0081; G0082; G0083; G0084; G0085; G0086; G0087; G2010; G2012; A6460; A6461; J7318; J7329; L8608; M1000; M1001; M1002; M1003; M1004; M1005; M1006; M1007; M1008; M1009; M1010; M1011; M1012; M1013; M1014; M1015; M1016; M1017; M1018; M1019; M1020; M1022; M1023; M1024; M1025; M1026; M1027; M1028; M1029; M1030; M1031; M1032; M1033; M1034; M1035; M1036; M1037; M1038; M1039; M1040; M1041; M1042; M1043; M1044; M1045; M1046; M1047; M1048; M1049; M1050; M1051; M1052; M1053; M1054; M1055; M1056; M1057; M1058; M1059; M1060; M1061; M1062; M1063; M1064; M1065; M1066; M1067; M1068; M1069; M1070; M1071; T4545; V5171; V5172; V5181; V5211; V5212; V5213; V5214; V5215; and V5221.This is effective March 1, 2019.
Submit Authorizations Online
All authorization requests must be submitted via the CareWebQI Authorization tool on the Provider Portal, including all supporting documentation.
- If it is determined at the time of claims submission that the request for the authorization was submitted after the date of service, the claim will deny.
- Out-of-network providers need to call 844-450-1926 for instructions on submitting their requests.
- Retro- and post-service requests: CCHP does not review requests for services that have already been provided.
- For services that need an authorization, CCHP requires a prior authorization to be submitted for review before the date of service.
- Inpatient admissions require notification within 24 hours of admission in the Authorization tool.
- Post-service requests will be returned to the provider to be adjudicated on appeal, except for emergency or urgent care services.
- Authorization does not guarantee either payment of benefits or the amount of benefits.
For questions or assistance with your authorization request, call Together with CCHP Clinical Services Department at 844-450-1926
Affirmative Statement - Children’s Community Health Plan (CCHP) wants its members to get the best possible care when they need it most. To ensure this, we use an auto authorization process, which is part of our Utilization Management (UM) program. UM decision-making is based only on appropriateness of care and service, and existence of coverage. CCHP does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision makers do not encourage decisions that result in underutilization.