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June 24, 2018

Surgery and Procedures

To determine whether or not a surgery or procedure requires a Prior Authorization, please see the current Medicaid Fee Schedule

Please see Codes Requiring Telligen Review to determine if a prior authorization is required by Telligen.

To apply for access to the Telligen Portal please fill out the registration packet located in the document library on the Telligen site. Once approved, providers can submit a request to either Telligen or Medicaid’s Medical Care Unit, but not both.   

Those requiring a prior authorization, and are not reviewed by Telligen, are reviewed by the Medical Care Unit as established in the list of surgeries requiring prior authorization from Medicaid's Medical Care Unit.

The Medical Care Unit also reviews a select number of inpatient hospital procedure codes.

 

Medical Care Unit Authorizations

Prior authorizations that are not reviewed by Telligen should be faxed to the Medical Care Unit at 1 (877) 314-8779 on the Surgery and Procedure Prior Authorization Form. Please, include proof of medical necessity with your request. Requests are only accepted by fax.

The status of a prior authorization request may be checked online at the Molina Health PAS portal under “Authorization Status”, using your NPI, or by contacting Molina at 1 (866) 686-4272.

For other questions or general information, contact 1 (866) 205-7403.

Telligen, Inc. Authorizations

Prior authorization requests through Telligen, Inc. may be submitted:

Online: Telligen provider portal.
Fax: 1 (800) 826-3836
Mail: Telligen
670 East Riverpark Lane, Suite 170
Boise, ID 83706

The status of a prior authorization request may be checked online at the provider portal, or by contacting Telligen, Inc. at 1 (866) 538-9510.

Please, contact Telligen, Inc. at 1 (866) 538-9510 if you require additional information or assistance.

Inpatient Psychiatric Reviews

Effective January 1, 2018 - There has been an important change regarding the way Inpatient Psychiatric Reviews are processed by Telligen. Previously, Inpatient Psychiatric Reviews were submitted to Telligen on the first billed day.  Effective immediately, all Inpatient Psychiatric Reviews exceeding three consecutive days should be submitted to Telligen for a review due on the fourth consecutive billed day.  These Reviews are no longer required to be submitted on the first billed day. This change has been made to bring the Department into compliance with the Mental Health Parity and Addiction Equity Act, which states that accessing mental health and substance abuse disorder services are equitable and not more difficult to access than physical health services.  As such, Inpatient Psychiatric Review requirements more closely match those of General Inpatient Hospital Review requirements where the inpatient procedures do not otherwise require a prior authorization.  If you have any questions or comments, please contact Telligen at 1-866-538-9510.”

Contact

Medical Care Unit 

Phone: 1 (866) 205-7403
Fax: 1 (877) 314-8779

Telligen, Inc.

ATTN: Prior Authorizations
 670 East Riverpark Lane, Suite 170 
Boise, Idaho 83706

 Phone: 1 (866) 538-9510
Fax: 1 (866) 539-0365