Prior Authorization
Alaska Medical Assistance: Alaska Medicaid, Denali KidCare and Chronic & Acute Medical Assistance
Prior Authorization is required and issued for Alaska Medical Assistance recipients by the following authorizing entities based on service category:
Recipients:
Many health care services require prior authorization. It is the responsibility of your medical provider to contact the appropriate agency to authorize these service before providing the service. If you are a recipient and have questions about your coverage call the Recipient Helpline:
800-780-9972.
Health Care Providers:
Many health care services require authorization prior to services being administered. Four agencies are currently approved to provide "Prior Authorization" for Alaska Medical Assistance recipients. Each agency, listed below, provides prior authorization for specific services. Please view the services under each agency to determine the appropriate agency contact.
Alaska Medical Assistance
Please call
HMS (Healthcare Management Solutions, LLC):907-644-6800 or in-state toll-free number: 800-770-5650.
Provider Inquiry/Provider Services: 907-644-6800 (option 1) or toll-free: 800-770-5650 (option 1, 1).
Prior Authorization by HMS includes the following services:
-
all non-emergent, medically necessary transportation and accommodation services
- selected professional services (physician, advanced nurse practitioner, medical clinic, dentist, etc.) as indicated in billing manuals/fee schedules
- services in excess of annual or periodic service limitations stipulated in regulations (vision, mental health, substance abuse rehabilitation, etc.) as indicated in manuals/fee schedules
- most Durable Medical Equipment, selected medical supplies, and selected hearing aids as indicated in billing manuals/fee schedules
- all Respiratory Therapy
- all Home Health Care Services
- all private duty nursing
- all hospice care
- Chronic & Acute Medical Assistance (CAMA) program recipients requiring outpatient radiation and chemotherapy
- certain maternal/newborn admissions (see chart below)
Maternal/Newborn Stay Prior Authorization (PA) Chart | |
Mode of Delivery |
Submit Claims as Payable without PA |
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Administrative PA from HMS |
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Medical Necessity Review from Comagine Health |
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| | Vaginal Delivery | Total stay from admit to discharge is 2 days or less |
| Delivery/Birth is the day after admission, but discharge is within 2 days of delivery/birth |
| Either delivery/birth is more than one day after admission OR discharge is more than 2 days following date of delivery/birth |
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|
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| | Cesarean Delivery | Total stay from admit to discharge is 4 days or less |
| Delivery/Birth is the day after admission, but discharge is within 4 days of delivery/birth |
| Either delivery/birth is more than one day after admission OR discharge is more than 4 days following date of delivery/birth
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- selected pharmaceutical drugs as specified on Drugs Requiring Prior Authorization
Division of Senior and Disabilities Services (DSDS)
Monday - Friday 8:00am - 4:30pm (AK time)
907-269-3666 or 800-478-9996
907-269-3688 Facsimile
The Division of Senior & Disabilities Services provides Prior Authorization for the following services:
- administrative wait and swing bed stays at acute care facilities and all long term care (LTC) facility admissions and continued stays
- Home and Community-Based Waiver Services
- Personal Care Attendant (PCA) services
Comagine Health
Monday - Friday 6:30am - 6:00pm (AK time)
800-783-9207
800-826-3630 - Facsimile
Comagine provides Prior Authorization for the following services:
- selected inpatient and outpatient procedures and diagnoses, regardless of length of stay (see Select Diagnoses and Procedures PRE-CERTIFICATION List)
- all inpatient hospital continued stays exceeding three (3) days
- certain maternal/newborn admissions
- Outpatient Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), Positron Emission Tomography (PET), and Single-Photon Emission Computed Tomography (SPECT)
Comagine Health Prior Authorization List
Maternal/Newborn Stay Prior Authorization (PA) Chart | |
Mode of Delivery |
Submit Claims as Payable without PA |
|
Administrative PA from HMS |
|
Medical Necessity Review from Comagine Health |
|
|
|
|
|
| Vaginal
Delivery | Total stay from admit to discharge is 2 days or less |
| Delivery/Birth is the day after admission, but discharge is within 2 days of delivery/birth |
| Either delivery/birth is more than one day after admission OR discharge is more than 2 days following date of delivery/birth |
|
|
|
|
|
| | Cesarean Delivery | Total stay from admit to discharge is 4 days or less |
| Delivery/Birth is the day after admission, but discharge is within 4 days of delivery/birth |
| Either delivery/birth is more than one day after admission OR discharge is more than 4 days following date of delivery/birth |
|
Behavioral Health Authorizations
Monday - Friday 8:00am - 5:00pm (AK time)
800-783-9207
800-826-3630 - Facsimile
Comagine Health
Comagine Health provides prior authorization for the following behavioral health services:
- Psychiatric admissions and continued stays
- Residential Psychiatric Treatment Center (RPTC) admissions and continued stays