[et_pb_section fb_built=”1″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”0px||0px||true|false” global_colors_info=”{}”][et_pb_row module_class=”banner” _builder_version=”4.19.4″ _module_preset=”default” width=”100%” max_width=”100%” custom_padding=”0px||0px||true|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_image src=”https:\/\/wwwqa.cencalhealth.org\/wp-content\/uploads\/2023\/06\/authorizations-banner.jpg” title_text=”authorizations-banner” _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_image][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_row module_class=”wide” _builder_version=”4.19.4″ _module_preset=”default” custom_padding=”0px||0px||true|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][lwp_divi_breadcrumbs font_icon=”5||divi||400″ link_color=”#2684c0″ separator_color=”#000000″ _builder_version=”4.16″ _module_preset=”default” module_font_size=”12px” global_colors_info=”{}”][\/lwp_divi_breadcrumbs][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_4,3_4″ use_custom_gutter=”on” gutter_width=”2″ module_class=”wide” _builder_version=”4.19.4″ _module_preset=”default” custom_padding=”10px||||false|false” global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_sidebar area=”et_pb_widget_area_54″ show_border=”off” module_class=”cencal-sidebar” _builder_version=”4.16″ _module_preset=”default” header_text_color=”#FFFFFF” custom_css_title=”background-color: #2684C0;||padding: 1em 1em;” border_color_right=”RGBA(0,0,0,0)” global_colors_info=”{}” custom_css_widget__hover_enabled=”off|desktop”][\/et_pb_sidebar][\/et_pb_column][et_pb_column type=”3_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”Authorizations” content_max_width=”100%” _builder_version=”4.16″ _module_preset=”default” header_level=”h1″ header_text_color=”#2684c0″ custom_margin=”||0px||false|false” global_colors_info=”{}”][\/et_pb_blurb][et_pb_text _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n
CenCal Health cares about the members we serve and believes in processing authorizations in a timely manner. It is important for providers to understand the difference between referrals, treatment authorization requests and other types of authorizations that may be required and how to obtain each one.<\/p>\n
The new online form will require member validation for security, the consolidation of four online forms (RAF, TAR, 18-1, and 20-1) into one user friendly platform and the ability to view one main dashboard within the home screen so staff can see the status of authorizations submitted to a Specialist and CenCal Health.<\/p>\n
Providers can also utilize the new Utilization Management Authorization Download Form<\/a> for physical medicine services or our Behavioral Health Treatment (ABA) & Mental Health Authorization Form<\/a>. This can be used for providers that don\u2019t have access to our portal, when a contracted Primary Care Provider (PCP) wants to refer to an Out of Network provider, or when an Out of Network Provider would like to submit a medical request to CenCal Health.<\/p>\n When filling out this downloadable form, please print legibly so our team can read the details and enter the data elements appropriately.<\/p>\n To see if a TAR is required, go to the HCPCS\/CPT Procedure Code – Prior Authorization Requirement Search Tool<\/a> before the procedure is rendered and reimbursement can be made.<\/p>\n <\/p>\n<\/div>\n [\/et_pb_text][et_pb_toggle title=”Referral Authorization Form (RAF)” admin_label=”Referral Authorization Form (RAF)” module_class=”cen-tog” _builder_version=”4.19.4″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n A referral is the process of a Primary Care Provider (PCP) sending a member to another provider, like a specialist, for consultation or services that are not be provided by the PCP.<\/p>\n Some services do not require a Referral Authorization Form (RAF) and can be accessed by members directly, click on these links to\u00a0learn more about RAFs<\/a>, or view our\u00a0Frequently Asked Questions<\/a>\u00a0document.<\/p>\n [\/et_pb_toggle][et_pb_toggle title=”Treatment Authorization Request (TAR)” admin_label=”Treatment Authorization Request (TAR)” module_class=”cen-tog” _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n Certain medical procedures require prior authorization to ensure medical necessity and appropriateness of care. CenCal Health has made it easy to determine if a TAR is required by utilizing the <\/span>HCPCS\/CPT Procedure Code – Prior Authorization Requirement Search Tool<\/a>\u00a0for providers.<\/span><\/p>\n Learn more about TARs<\/a><\/p>\n Documentation of Medical Necessity for Intravenous Sedation & General Anesthesia for Dental Procedures\u00a0Referral Slip<\/a><\/p>\n CenCal Health members may request a second medical opinion regarding a recommended procedure or service through their PCP. The plan must review the request for medical necessity.<\/p>\n [\/et_pb_toggle][et_pb_toggle title=”Self-Referral Services” admin_label=”Self-Referral Services” module_class=”cen-tog” _builder_version=”4.19.4″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n Certain Medi-Cal covered services do not require prior authorization, irrespective of whether the member seeking the service is enrolled in CenCal Health.<\/p>\n To obtain more information about services not requiring prior authorization, please call Provider Services at (805) 562-1676<\/a>.<\/p>\n [\/et_pb_toggle][et_pb_toggle title=”Medical Pharmacy Benefit Authorizations” admin_label=”Medical Pharmacy Benefit Authorizations” module_class=”cen-tog” _builder_version=”4.19.4″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n Certain medical procedure require prior authorization to ensure medical necessity and appropriateness of care. CenCal Health has made it easy to determine if a TAR is required by utilizing the HCPCS\/CPT Procedure Code-Prior Authorization Requirement Search Tool <\/a>for providers.<\/p>\n Any request for a medication via CPT-Code (i.e J-Code) to be administered at a provider’s office or infusion\/hospital facility must be submitted as a medical authorization request (treatment authorization request – TAR) through the Provider Portal.<\/p>\n [\/et_pb_toggle][et_pb_toggle title=”Radiology Authorizations” admin_label=”Radiology Authorizations” module_class=”cen-tog” _builder_version=”4.19.4″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n Prior authorization for high-tech imaging services is required to be completed by the ordering provider.<\/p>\n Services requiring radiology authorization include:<\/strong><\/p>\n Learn more about our Radiology Benefit Manager\u00a0<\/a><\/p>\n<\/div>\n [\/et_pb_toggle][et_pb_toggle title=”Medical Transportation Services” admin_label=”Medical Transportation Services” module_class=”cen-tog” _builder_version=”4.23.4″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n CenCal Health covers transportation to and from medically necessary services, such as doctor appointments, specialty mental health, substance use disorder, dental, pharmacy pick up, medical supply pick up and more.<\/p>\n CenCal Health partners with Ventura Transit System (VTS) to schedule and manage transportation services for our member. Non-Emergency Medical Transportation (NEMT) and Non-Medical Transportation (NMT) are covered services for CenCal Health members.<\/p>\n Medical Transportation Services Reference Guide<\/a><\/p>\n Non-Medical Transportation (NMT)<\/strong><\/p>\n Non-Emergency Medical Transportation (NEMT)<\/strong><\/p>\n Authorization Requirements:<\/strong><\/p>\n Transportation Eligibility:<\/strong><\/p>\n Types of NEMT Transportation<\/strong><\/p>\n AMBULANCE service\u00a0<\/strong>may be used for:<\/p>\n LITTER VAN service\u00a0<\/strong>may be used when the member\u2019s medical and physical condition does not meet the need for NEMT ambulance services, but meets both of the following:<\/p>\n WHEELCHAIR VAN service<\/strong>\u00a0may be used when the member\u2019s medical and physical condition does not meet the need for litter van services, but meets any of the following:<\/p>\n AIR Transport<\/strong>\u00a0for NEMT will be provided only when transportation by air is necessary because of the member\u2019s medical condition or because practical considerations render ground transportation not feasible.\u00a0 The necessity for transportation by air shall be substantiated in a written order of a physician, dentist, podiatrist, or mental health or substance use disorder provider.<\/p>\n Members and\/or Providers may contact Ventura Transit System (VTS) directly at (855) 659-4600 for transportation services or please call CenCal Health\u2019s Member Services Department at 1 (877) 814-1861 for assistance.<\/p>\n [\/et_pb_toggle][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"Second Opinion<\/h3>\n
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