Notice Regarding Incontinence Garments: Starting January 1, 2010, the Medicaid DME benefit coverage of incontinence garments (disposable diapers, liners and underwear/pull-ups and diaper service including T4521-T4535 and T4538) for adults will change to 200 a month. The Medicaid DME benefit coverage of incontinence garments (disposable diapers and underwear/pull-ups) for adults was 300 a month through December 31, 2009. Please note that incontinence codes T4535 and T4538 are also subject to these parameter changes and that any clarifying revisions to the Medicaid Supply List OAC rule 5101:3-10-03 will be made at the department's earliest opportunity.

Prior Authorization (PA)/Prospective Review Area

This area ensures that all Medicaid services requiring prior authorization are medically necessary and appropriate; evaluates and prices (when necessary) PA requests for medical, transportation, durable medical equipment, organ transplantation, supplies, and dental and vision services.
Fax: 1-614-752-8387

Ohio Medicaid providers may contact our Interactive Voice Response (IVR) system for billing concerns. The IVR is available 24-hours, 7-days a week. Call: 1-800-686-1516.

Things to remember:

• For all Pediatric and/or Healthchek PA requests, please indicate "CHILD" on the top of form JFS 03142

• When submitting PA requests for wheelchair repairs, look at the warranty to determine if it is a covered repair.  Providers cannot bill Medicaid for covered repairs

• To maintain HIPAA compliance, always refer to NAS PDAC when selecting codes for all DME.  The use of incorrect codes will result in denials

1. When requesting Enteral Nutrition products remember:
   1. 1) one unit equals 100 calories and
   2. 2) deduct the amount provided by the Women, Infants and Children (WIC) Program
      
2. Miscellaneous Codes (e.g., E1399, K0108) are for truly unique items for which there is no applicable or available HCPCS code  

The total turn around time for PA request processing is based on receipt of accurately completed, legible, Prior Authorization Request (JFS 03142 ), including all appropriate documentation and required Certificates of Medical Necessity. PA Requests are reviewed on a first-in/first out basis, according to the date received by the Prior Authorization Unit. Please do not send duplicate PA Requests. Submitting duplicate requests will prolong response time.