Wiki Prior Auth and H0015

[rsjbic32]

Prior Auth is required for PHP LOS (H0015-TG) for OH Medicaid. If PHP is denied authorization by payer (H0015 - TG) can we automatically bill IOP? Client has been in PHP during waiting period for authorization to be completed, and I wanted to make sure if the PHP was denied if it is ok to lower the LOS to IOP even though client was actually attending PHP x 10 days.

 

[dvarn567]

If we do not have auth (either because was denied, staff didn't get, etc) we will bill H0015-HK-provider modifier instead of H0015-HK-provider modifier-TG to OH Medicaid. I have never had any issue with changing it.