Service Authorizations

Overview

Many health care services require service authorization. It is your medical provider's responsibility to contact them for authorization before providing the service. If you have questions about your coverage, call the Recipient Helpline: 1-800-780-9972.

Services requiring prior authorization

Division of Health Care Services (HCS)

HCS authorizations include the following:

• All non-emergent, medically necessary transportation and accommodation services
• Select 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 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
• Certain maternal/newborn admissions
• Selected pharmaceutical drugs as specified on Drugs Requiring Prior Authorization
• Outpatient Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), Positron Emission Tomography (PET), and Single-Photon Emission Computed
• Selected inpatient and outpatient procedures and diagnoses, regardless of length of stay (see Select Diagnoses and Procedures PRE-CERTIFICATION List)

See prior-authorized drugs

Comagine Health Prior Authorization List

Division of Senior and Disabilities Services (SDS)

SDS authorizations include the following:

• 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

Division of Behavioral Health (DBH)

DBH authorizations include the following 1115 Behavioral Health Reform Waiver Services:

Please review the 1115 Waiver Service Authorizations Recap memo for an important program update.

• Alaska Behavioral Health Providers Services Standards & Administrative Procedures for Behavioral Health Provider Services
  • Crisis Residential & Stabilization; after 7 days
  • Therapeutic Treatment Homes; after 90 days
  • Children's Residential Treatment, Level 1; after 90 days
  • Children's Residential Treatment, Level 2; after 90 days
  • Adult Mental Health Residential Treatment, Level 1; after 90 days
  • Adult Mental Health Residential Treatment, Level 2; after 180 days
• Alaska Behavioral Health Provider Service Standards & Administrative Procedures for Substance Use Disorder (SUD) Provider Services
  • Crisis Residential & Stabilization; after 7 days
  • ASAM 3.1 SUD Residential; after 90 days
  • ASAM 3.2 Withdrawal Management; after 14 days
  • ASAM 3.3 SUD Residential; after 90 days
  • ASAM 3.5 SUD Residential; after 90 days
  • ASAM 3.7 SUD Residential; after 14 days
  • ASAM 3.7 Withdrawal Management; after 14 days
  • ASAM 4.0 SUD Residential; after 14 days
  • ASAM 4.0 Withdrawal Management; after 14 days

Please Note: Comagine Health will continue to provide authorizations for the following State Plan behavioral health services:

• Residential Psychiatric Treatment Center (RPTC) admissions and continued stay reviews.
• All inpatient psychiatric admissions and continued stays exceeding three (3) days.

Prior Authorization Metrics

To comply with the CMS Interoperability and Prior Authorization final rule, the Division of Health Care Services is required to annually report aggregated prior authorization metrics on our website. This includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (e.g., approvals, denials, etc.) over the previous calendar year. Alaska Medicaid uses a Fee-For-Service (FFS) program so all data has been aggregated at the state level.

Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. For questions on the data, contact doh.hcs.info@alaska.gov

Resources