Md. Code Regs. 10.09.08.09

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.08.09 - Preauthorization Requirements

A. The following procedures or services require preauthorization:

(1) Vision care according to COMAR 10.09.14.06 and COMAR 10.09.23;

(2) Mental health services which shall comply with the requirements of COMAR 10.09.59;

(3) Substance use disorder services which shall comply with the requirements of COMAR 10.09.80; and

(4) Dental services which shall comply with the requirements of COMAR 10.09.05.

B. The Department or it's designee shall preauthorize services when the provider submits adequate documentation demonstrating that the service to be preauthorized is medically necessary.

C. Preauthorization is valid only for services rendered or initiated within 60 days of the date preauthorization was issued. The patient shall be an eligible participant at the time the service is rendered.

D. Preauthorization normally required by the Program is waived when the service is covered and approved by Medicare. However, if the entire or any part of a claim is rejected by Medicare, and the claim is referred to the Program for payment, payment shall be made for services needing preauthorization from the Program only if authorization for those services has been obtained before the services were rendered.

Md. Code Regs. 10.09.08.09

Regulations .09 repealed effective October 1, 1985 (12:19 Md. R. 1849)
Regulations .09 adopted effective October 1, 1985 (12:19 Md. R. 1849)
Regulation .09E amended effective April 4, 2011 (38:7 Md. R. 430)
Regulation .09 adopted effective 42:6 Md. R. 512, eff.4/1/2015; amended effective 50:20 Md. R. 886, eff. 10/16/2023