Issued: June 28, 2023
To ensure accuracy and efficiency in processing authorizations, Partners will require providers to submit prior authorization requests for pass-through units in ProAuth beginning July 1, 2023.
What is happening?
Pass-through authorizations will no longer be approved automatically in ProAuth for the following services:
| Service Description | Funding Source |
| Adult Facility Based Crisis (FBC) – S9484 | Medicaid and State |
| Adult Electroconvulsive Therapy (ECT) – 0901 | Medicaid and State |
| Ambulatory Detox – H0014 | Medicaid and State |
| (b)(3) Individual Support – T1019 U4, T1019 U4 TS, T1019 U4 DJ, T1019 U4 EP | Medicaid |
| (b)(3) Supported Employment – H2023 U4 HE, H2023 U4 HE DJ | Medicaid |
| Community Support Team (CST) – All Service Code H2015 HT HO | Medicaid and State |
| Individual Placement and Support (IPS)-Supported Employment (SE) – YP630, YP630 BC, YP630 DJ, YP630 BC DJ | State |
| IPS-SE NC Core – H2023 Z1, H2023 U4 Z1 | Medicaid and State |
| Multi-Systemic Therapy (MST) – H2023 M1, H2023 M1 PB | Medicaid |
| Non-Hospital Medical Detox – H0010 | Medicaid and State |
| Outpatient – Service Code 90870 | Medicaid and State |
| Social Setting Detox – YP790 | State |
| Substance Abuse Comprehensive Outpatient Treatment Program (SACOT) – H2035, H2035 OT | Medicaid |
| Substance Abuse Intensive Outpatient (SAIOP) –H0015, H0015 OT, H0015 AD | Medicaid |
| Transitional Therapeutic Foster Care – S5145 TT | Medicaid and State |
Utilization Management (UM) Reviewers will process the pass-through authorizations according to the benefits outlined on the Provider Knowledge Base: providers.partnersbhm.org/benefit-grids.
These requests will be prioritized, and reviewers will administratively approve valid and complete authorizations within the benefit limits. No medical necessity review will be required.
When is this happening?
Effective July 1, 2023
What do providers need to do?
Providers need to submit prior authorization requests for pass-through units in ProAuth. (No clinical documentation is required.)
Providers should document that they are submitting for the pass-through period within the notes of the authorization request in ProAuth. Requests should be submitted within 7 calendar days of the first day of service delivery.
What if providers have questions?
If providers have authorization-related questions, contact Utilization Management at UMQuestions@PartnersBHM.org.