October 3, 2019
Starting on October 19, we’re launching a newly enhanced prior authorization online tool. The new enhancements give provider offices more detailed information when requesting prior authorization for their patients.
Enhancements include:
- Clear, detailed prior authorization requirements based on the patient’s diagnosis and benefit coverage
- New options for inpatient and durable medical equipment (DME), home health, and infusion (formerly fax requests-only)
- Time-saving links to medical policies
These enhancements are part of a November 1 Washington state mandate. The mandate requires that payers have online systems for telling providers if 1) a service requires review, 2) if the service is a covered benefit 3) if any pre-service requirements apply and the clinical review criteria used to evaluate the request, and from there, 4) allows the provider to submit a prior authorization request.
Attachments now required
Providers may need to prepare for the new attachments requirement. All prior authorizations will now require providers to attach supporting documentation before a prior authorization can be submitted. Attachments could include recent history and physical, care plan, and documentation of medical necessity.
Register with OneHealthPort
Since the prior authorization tool is secure, you’ll need to register with OneHealthPort for tool access. This is an important step for DME and infusion providers who are new to this process.
Provider education, training
We’ll be updating our prior auth user guide to help you learn more about how to use the tool. This guide is an especially helpful resource for our DME and infusion drug providers who are new to this process.