PA Adjustment Training

How to complete a PA Adjustment First you will need the PA number, the Member ID number, and the start date for the PA you wish to be adjusted. Next you will need to click on the PA Adjustment Tab (located under CDC Search in PICIS)

Click Add New if you are requesting a PA to be changed Searching for a PA Adjustment Request: enter Member ID and PA number Click search.

After clicking Add NEW you will be to the PA Adjustment Request Screen.

Insert your Contact information, your name, your , your phone. Insert your Contact information, your name, your , your phone (not the customers).

Insert the Recipient ID and PA Number

PA Request Types

Three Types of Request Types Exceptional Case: A request for PA Adjustment may be submitted when a client’s condition is severe enough to require an intensity of outpatient services higher than Level Four Medical Necessity Criteria, and all Medical Necessity Criteria for Exceptional Case are met. Rehab for Ages 4-5:A request for PA Adjustment may be submitted when a provider is seeing a child age 4 or 5 for psychotherapy services, there is a defined need for behavioral health rehabilitation services to compliment these more intensive therapies, and all Medical Necessity Criteria for this level of service are met.

Three Types of Request Types (cont.) Correct Authorization: A request for PA Adjustment may be submitted when a provider finds any errors or discrepancies on a PA (i.e., typographical error, wrong provider number, wrong procedure group code, wrong Recipient ID number, and some instant authorization edits) regardless of who made the error. Be sure before doing a Correct Authorization that you have not billed on the prior PA for the dates that you are needing corrected, if so you will need to void those claims out.

Exceptional Case is for clients above a Level 4 You will need to include the following Documented support for the need for a 30-day period of increased services beyond what is supported by a Level 4 authorization. A copy of the Behavioral Health Assessment Service Plan for the individual Request Type 1: Exceptional Case (for agencies only)

The Start Date is the date you want the PA to start To attach the behavioral health assessment and service plan Click browse, find the document, and then click attach This is what it looks like after you have attached a document.

Request Type 2: Rehab for Ages 4-5 (for agencies only) Rehab for ages 4-5 is when you are need rehab for under the age of 6. You will need to include the following Documented support for the need for rehabilitation services in the treatment of the designated child Documented support that the child has the ability to benefit from curriculum based education, including a description of the child’s development as it relates to developmental expectations for age and stage particularly in the areas of cognition and language Information regarding the curriculum to be used A copy of the Behavioral Health Assessment Service Plan for the individual

To attach the behavioral health assessment and service plan Click browse, find the document, and then click attach

Request Type 3: Correct Authorization This Request type is for any other adjustments that need to be made to the PA Date correction Incorrect Provider Number

Date Correction For the Start Date indicate the date you need the PA to start and give a brief explanation. For all other corrections indicate the start date for the PA and give a brief explanation of what corrections needs to be done.

Contact Information PICIS HelpDesk or