List of Services Not Requiring Authorization (Medicaid only)
Request to Add Code to Medicaid No Authorizations List Request Form (Medicaid only)
List of DME Services Not Requiring Authorization (Medicare only)
Partnering with Performance Health Technology for Claims Processing
This year, we partnered with Performance Health Technology (PH Tech) to process our Medicaid and Medicare claims. As part of the initial transition, all providers were informed and given instructions about the change to our required authorization process. Specifically, this necessitates information to be entered for consultation referrals and other services into PH Tech’s Clinical Integration Manager (CIM). The system is set up to provide automatic approval for those services that don’t require medical review, and when the information is added, the system provides immediate authorization. If the service requires medical referral, a notice is sent to inform you that the request is pending, and FamilyCare will process the authorization request as usual. As before, there are no changes in the authorization rules – just the need to submit the referrals into the CIM system. If you are a FamilyCare provider and you need access to the CIM system, contact our Provider Navigation Services at (503) 222-2880 or 1-800-458-9518.
Use the following forms to request authorizatons. You will be asked to complete a request form with the option of submitting electronically or printing a copy to fax to our offices. The fax number is listed on each form.
- PCP to Specialist
- Infusion Therapy
- Radiation Therapy
- Home Health
- Psychological Testing
- Synagis Therapy
- A&D Residential Authorization
- Children's Respite Request Form
- ISA Referral Packet
- Outpatient, Mental Health & Chemical Dependency Authorization
- Morrison Respite Form
Assigning members to a Primary Care Provider
All members are assigned to a primary care provider (PCP) shortly after their enrollment to FamilyCare. If you agree to see a FamilyCare member for a non-emergency, regular office visit and you aren’t the assigned PCP, the claim will be denied. If you call our Provider Navigation Services Dept. (see the numbers below) prior to the appointment, we can assist in getting the member assigned to you so the claim for the care is approved.
Again, we are committed to our claims processing and our service to you. If you have any questions or concerns, please call our Provider Navigation Services at (503) 222-2880 or 1-800-458-9518.