Sandhills Center LME

Service Authorization Process

Before requesting authorization for services via Carelink, agencies must make sure that all necessary forms and documentation have been filled out completely and accurately, then submitted to the LME. Such forms include:

• Valid Target Population and Diagnosis. Target Population and diagnositc information must agree with the DHHS Diagnosis/Target Population Crosswalk, and be appropriate for the service being requested (see the DHHS Array of Services and the Service Definitions for more information). Authorization and/or payment denials will result if these elements are not correct. See the following DHHS documents for more information on Target Populations:

            Descriptions of the Target Populations: Adult MH   Adult SA   Adult DD   Child MH   Child SA   Child DD  

            Additional Target Population Documentation: Eligibility Concurrency Table   Target Pop Eligibility Matrices   

• Updated Medicaid Status and Financial Information.
• Release of Information Form
• Consumer Choice Form

Making an Authorization Request

Initial authorization requests are to be keyed into Carelink PRIOR to delivering the service when at all possible. Exceptions would be for services outside of regular business hours put in place on an emergency basis.

Reauthorization requests are to be entered into Carelink 10 days PRIOR to delivering the service to the consumer. This allows time for the care manager to review the request and contact the provider concerning any additional information needed in order to approve. Failure to do this may result in a denial. Each provider agency is responsible for entering authorization requests for the services they provide. Clinical home agencies can not make authorization requests for other providers.

The "Comments" section at the bottom of the of the Carelink authorization request should include a contact person for your agency, and phone number and/or email address, as well as a clinical reason why the service is medically necessary at the level being requested. Insufficient information may result in delay of approval or a denial.

Please be aware that due to limited funds, the authorization period for IPRS services may not extend more than one quarter of the fiscal year for most services.

For questions concerning existing authorizations, please contact the assigned care manager listed on the authorization. Be sure to include the consumer record number, the authorization number, and the specific issue. Failure to provide this information will result in a delay of resolution.

Insurance Status Changes

Providers are expected to verify insurance status with each consumer or his/her legal guardian at least monthly and inform the LME immediately whenever a consumer gains or loses Medicaid or has any other change in insurance status.

Termination of Services

Anytime a consumer discontinues services for any reason, and has units remaining in an authorization, the provider agency is responsible for contacting the LME within 5 working days of the consumer exiting services by faxing a completed Sandhills Center LME Authorization Cancellation Form to the Service Management Department at (910) 673-7805.

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