Medicaid Review Services and ProgramsWhat's NewDue to a request from Medicaid, our Prior Authorization (PA) number formatting has changed, effective 7/1/10. All AFMC PA numbers now begin with the letter A. Beginning March 1, 2008, AFMC began using InterQual screening criteria for all admission and continued stay reviews. InterQual criteria is used for initial screening only, and is not used by the AFMC physician advisors when making review determinations. There is no requirement that hospitals purchase InterQual criteria. The review department of AFMC is made up of review coordinators (nurses and health information management professionals), physicians and clerical support staff. Twenty review coordinators are located in the Fort Smith office and perform a variety of review functions. Fourteen review coordinators live in cities and towns around the state, and perform reviews in hospitals in their region of the state. The review department of AFMC performs a variety of prior authorization and retrospective reviews for Medicare, Medicaid and private insurance companies. The initial screening review is performed by a review coordinator. If an admission, length of stay, or procedure does not meet initial screening criteria, the case is referred to a physician advisor. Only a physician may make the decision to deny coverage of an admission, length of stay or procedure. |
