Prior Authorization Requirements for Child Health Plus
A payer-specified list of non-drug medical items and services that require prior authorization for members covered under the MVP Health Care Child Health Plus Plan. Affects providers seeking authorization for listed services for Child Health Plus members in the plan's applicable state(s).
No material clinical or coverage changes in this revision.
Coverage Criteria
This document lists medical items and services that are subject to prior authorization for members enrolled in the MVP Health Care Child Health Plus plan. Drugs are excluded from this list; the list covers only non‑drug medical items and services. Providers should consult the enumerated services when determining authorization needs prior to delivering care.
Coding
| No codes listed |
Provider Actions & Authorization Requirements
Prior Authorization Required
Providers must obtain prior authorization before providing any of the non-drug items and services listed below to Child Health Plus members. Failure to obtain prior authorization may result in claim denials or payment delays. When prior authorization is required, submit requests to MVP Health Care per standard prior authorization channels and include all supporting clinical documentation.
- Acute Inpatient Rehabilitation
- Air Medical Transport/Air Ambulance (non-emergency transport)
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