Comprehensive Community Support Services Frequently Asked Questions (FAQ)
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Describes Meridian's prior authorization requirements and submission process for Comprehensive Community Support Services (codes H2015, H2016) for Meridian Medicaid and MMAI members, including timelines, documentation, and submission methods.
Prior authorizations will be required for Comprehensive Community Support Services (codes H2015 and H2016) after the first 90 days of service beginning April 1, 2024.
Backdating of prior authorization requests will be allowed through August 31, 2024; portal backdating issues can be mitigated by fax submission.
Prior Authorization Coverage Criteria and Process
Prior Authorization Coverage Criteria and Process
Prior authorization for Comprehensive Community Support Services (codes H2015 and H2016) will be granted when submitted clinical documentation demonstrates need and progress; providers will receive approved timeframes and next concurrent review due dates upon completion.
ALL of the following
- Initial documentation: Include initial assessment; up-to-date clinical notes; the most current treatment plan showing member participation and evidence the member benefits from services.
- Ongoing documentation: Provide updated assessments and assessment tools (e.g., IMCANS); evidence that the treatment plan is reviewed at least monthly by the community support team; documentation of member participation and progress to support continued services; documentation to be provided at each concurrent review.
ALL of the following
- The one-time waiver: prior authorization will not be required for the first 90 days of a new episode of service; providers are responsible for tracking the initial 90 days and submitting prior authorization requests thereafter.
- Examples: a member who starts services 7/1/24 would require a prior auth by 10/1/24; members currently in care as of 4/1/24 will require an authorization by 7/1/24 and ongoing as care is requested and provided.
ALL of the following
- Submission channels: Providers are encouraged to submit clinical documentation via the provider web portal (Log In Illinois Medicaid Plan); portal allows direct uploads (file names cannot contain spaces).
- If portal backdating or submission issues occur, providers may fax clinical records and prior authorization forms to outpatient fax 833-544-1828; backdating of requests is allowed through August 31, 2024 while portal issues are mitigated.
ALL of the following
- When submitting prior authorization forms via fax include the billing NPI on the form.
- Modifiers are not required on the prior authorization request; the fax prior auth form available on Meridian’s website is required only for faxed requests and not for portal submissions.
ALL of the following
- Providers should submit date ranges and units based on the needs of the member; providers with portal accounts may upload documentation directly or create a new account if needed.
Affected Codes and Waiver Period
Provider Requirements and Submission Process
Prior authorization required for H2015/H2016 starting 4/1/2024
Prior authorization is required for HCPCS codes H2015 and H2016 beginning April 1, 2024, after the one-time 90-day waiver period; providers must submit date ranges and units based on member needs.
- Requirement starts 4/1/2024 after initial 90-day waiver
- Submit date ranges and units based on member needs
Use portal for submissions; fax permitted for backdating through 8/31/2024
Submit clinical documentation via the provider web portal (Log In Illinois Medicaid Plan) whenever possible; clinical files uploaded to the portal cannot have spaces in the file name. If you cannot backdate a portal request, fax documentation to outpatient fax 833-544-1828. Meridian continues to allow backdating of requests through August 31, 2024.
- Portal is preferred and supports direct uploads (file names cannot contain spaces)
- Fax accepted to 833-544-1828 for submissions and to mitigate portal backdating issues
- Backdating allowed through 8/31/2024
Include billing NPI on faxed prior auths; modifiers not required
For prior authorization forms submitted via fax, include the billing NPI on the request; providers do not need to include modifiers as part of the request.
- Include billing NPI on faxed prior authorization forms
- Modifiers are not required on the request
Standard TAT: 4 days from receipt
Standard turnaround time (TAT) for prior authorization requests with a standard level of urgency is four days from the date the request is received.
- TAT = 4 days from receipt for standard urgency
Applies only to Medicaid and MMAI members; excludes YouthCare and MLTSS
The prior authorization requirement for H2015 and H2016 applies only to Meridian Medicaid and MMAI members and does not apply to YouthCare or MLTSS members.
- Applies to Medicaid and MMAI members only
- Excludes YouthCare and MLTSS
Key Terms
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