Section 17b-262-963 - Prior authorization(a) The department shall require prior authorization for:(1) Any service identified on the department's fee schedule as requiring prior authorization;(2) EPSDT special services; and(3) any service that is not identified on the department's fee schedule.(b) To receive reimbursement from the department, a provider shall comply with all prior authorization requirements. The department, in its sole discretion, shall determine what information is necessary to approve a prior authorization request. Prior authorization does not guarantee payment unless all other requirements are met.(c) The provider shall submit and sign the prior authorization request, in a form and manner specified by the department, which shall include documentation of medical necessity.(d) A prescription is required from a licensed practitioner for all services and goods provided as EPSDT special services. The provider may attach a copy of the prescription from the licensed practitioner to the completed prior authorization request in lieu of the actual signature of the licensed practitioner on the prior authorization request form. The provider shall keep the licensed practitioner's original prescription on file and available for review by the department.Conn. Agencies Regs. § 17b-262-963
Effective October 2, 2012