Md. Code Regs. 10.09.09.06

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.09.06 - Preauthorization Requirements

A. Preauthorization is required for any service identified as needing preauthorization in the current laboratory fee schedule, in accordance with Regulation .07D of this chapter.

B. The provider shall submit the request for preauthorization according to the procedures established by, and in the form designated by, the Department.

C. Preauthorization is issued when:

(1) Program procedures are met; and

(2) The provider submits to the Department adequate documentation demonstrating that the service to be preauthorized is medically necessary.

D. Preauthorization is valid for services rendered or initiated within 90 days of the date issued.

E. Preauthorization for Services Billed to Medicare.

(1) If Medicare covers and approves a service for which preauthorization by the Program is normally required, the Program shall waive preauthorization requirements for that service.

(2) If Medicare rejects the entire claim or any part of a claim for a service that normally requires preauthorization, and the claim is referred to the Program for payment, the Program shall pay only for the Medicare-rejected covered services if authorization for those services was obtained prior to the date of service.

Md. Code Regs. 10.09.09.06

Regulation .06 amended effective 50:14 Md. R. 593, eff. 7/24/2023