Revision of Form HFS 1409 Prior Approval Request and Availability on the Website
To: Participating Advanced Practice Nurses; Audiologists; Durable Medical Equipment and Supplies Providers; Health Departments; Home Health Agencies; Hospitals; Optical Companies; Optometrists; Pharmacies; Physicians; and Podiatrists
Date: January 26, 2016
Re: Revision of Form HFS 1409 Prior Approval Request and Availability on the Website
The Department has recently reformatted the HFS 1409 Prior Approval Request form. There are no changes to the content of the form. It has been assigned a revision date of R-11-15 in the bottom left corner of the form. Please ensure that you are using this most current version when submitting a prior approval request.
As had been the case with earlier versions of this form, the new version is available in a PDF-fillable format on the Medical Forms Page of the website. Please begin using this new version of the Prior Approval Request form immediately. The Department will no longer stock a paper version of the HFS 1409 for ordering from the HFS warehouse. Providers must print off the website version for submission to the Department.
The prior approval instructions in this notice apply to patients enrolled in traditional fee-for-service, Accountable Care Entities (ACEs) and Care Coordination Entities (CCEs) and do not apply to patients enrolled in Managed Care Organizations (MCOs) and Managed Care Community Networks (MCCNs).
It is imperative that providers check HFS electronic eligibility systems regularly to determine beneficiaries’ enrollment in a plan. Electronic Data Interchange vendors (formerly the Recipient Eligibility Verification (REV) System), the Automated Voice Response System (AVRS) at
1-800-842-1461, and the Medical Electronic Data Interchange (MEDI) system will identify any care coordination plan in which the beneficiary is enrolled. Plan contact information for questions related to coverage and billing requirements as well as information regarding the way each plan is displayed in the department’s electronic eligibility systems may be located in the March 9, 2015 informational notice titled, Care Coordination Health Plan Identification and Billing Procedures Depending on Health Plan Enrollment (pdf). Prior approval requests for participants in an MCO or MCCN should be directed to the individual plan.
If a participant becomes enrolled in an MCO or MCCN during a period of time for which a prior approval has been previously granted, the prior approval will no longer be applicable effective with the participant’s managed care enrollment date.
Any questions may be directed to a medical assistance consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.
Felicia F. Norwood