A snapshot of Georgia: Children's Intervention Services prior authorization, a program of the Georgia Department of Community Health [Jan. 2008]

A Program Of The Georgia Department Of Community Health
A SNAPSHOT OF GEORGIA
Children's Intervention Services Prior Authorization

2007 Improvements
The Georgia Department of Community Health (DCH) has taken numerous steps to improve the Children's Intervention Services' (CIS) Prior Authorization (PA) Process. Below is a summary of those actions:
Extended approval up to six months Enabled providers to electronically attach supporting documentation Added a Web portal training program to assist providers Developed a tracking process to facilitate administrative reviews Extended time for providers to submit additional information to 10 days Continually update frequently asked questions on the Web site Created dedicated toll free fax lines Over 98 percent of all PA request determinations are made within 10 days Increased number of CIS peer consultants reviewers (now over 30 reviewers) Created mechanism for smooth transition of PA's between fee for service and CMO Provided numerous training sessions both on-site and via telephone for several
providers Enabled use of electronic signatures on required documentation for PA requests Enabled change request process to allow modification of existing PA's Enabled a "retro PA request" when an emergent need arises
Previous Improvements
Combined letter of medical necessity and plan of care into one document Decreased duplicate entries required on the PA request forms Allow providers to request PA's 30 days in advance of beginning services Simplified information required on prescriptions Significantly reduced submission requirements from IEP/IFSP Permit providers to send only updated data with subsequent PA requests Provided a dedicated e-mail box that providers can use to direct questions

PROVIDER FEEDBACK
I just wanted to take a minute to say thank you for all you
have done in making the prior approval process for CIS run more smoothly. My average
turnaround time for a multidisciplinary practice of 14-15
therapists is 10 days to two weeks now. The documentation
required is something that we have always done, so I don't feel that the request for it is unreasonable. The difference in this process now, and a year ago is light years, and I greatly appreciate all you have done to help those of us in the trenches.
- Multi Provider Group Practice

Consolidation of Processes
DCH remains committed to coordinating functions with Care Managed Organizations'(CMO) to provide a reasonable process for providers that enhance the care for children. To address concerns regarding differing processes and policies between different CMOs and DCH fee-forservice (FFS) the three CMOs and DCH have agreed to the following:
Authorize services for six month time period for chronic conditions Consistency in the number of units authorized per time period (with variation based
on medical needs of child) Uniformity regarding information required for prior authorization review Consistency in use of standardized testing and criteria utilized to establish medical
necessity

I am so excited to see the change in PAs from three to six months!! I am actually able to attend my own children's sporting events now that the paperwork obligations have decreased.
- Physical Therapy Provider

2 Peachtree Street, Atlanta, Ga 30303 www.dch.georgia.gov

January 2008

Children's Intervention Services Prior Authorization
Provider Participation DCH has carefully monitored the participation of providers to ensure appropriate access for children. Active provider participation (measured by continuing to submit see patient and submit claims) has remained essentially the same for the child Aged, Blind and Disabled (ABD) groups:
111 children per therapist in FY 06 117 children per therapist in FY 07 Prior Authorization Disposition
Since July, the Georgia Medical Care Foundation has average disposition time of 98.8 percent of all CIS PA requests complete in 10 days or less
Most recent month; nearly 70 percent were approved on first pass Most common reason for denial is incomplete or omitted information 73 percent approved once added information provided on administrative review