Paragon Benefits Authorization Request Form

Submit all documents for long-term home care permits directly to Kepro. Do not send applications to DHS. The GCSP will not process or forward requests for documents. The MHCP will continue to process CPA requests and technical amendment requests for home care services. For more information on these requirements, refer to the EMA Kidney Transplantation Services section of this guide. Send an authorization request to Kepro as described in the table above and upload, fax or email the MCO approval with a statement requesting administrative approval for continuity of care. Send the following types of applications to Kepro, the medical investigator (select the type to learn more about the submission): Paragon`s customers experience first-hand the cost-effective and undeniable benefits of engaging in collaboration and making all future healthcare decisions based on statistical data and information. With the exception of home care requests and CADDI authorization, the GCSP will not consider a request for approval of a service or item for a Medicare member or LTA unless the provider has made a good faith effort to obtain approval or payment from the primary payer(s). The MHCP Resource Center cannot determine the status of pending permissions. Because we offer both of these benefits, we strive to be efficient, timely and informative on a daily basis. Strategic tools such as our new ergonomic Paragon Pods office structure, our state-of-the-art VBA software system and our focus on COMM initiatives allow us to provide you with the best and most accurate service. If the reviewer rejects a request for reconsideration, the provider may submit a request for reconsideration of the second stage in writing within 30 calendar days of the rejection of a request for reconsideration by requesting a peer review or peer review committee. The HSCP must be approved as a condition of payment for the MHCP if a health service, including a drug, meets one of the following conditions: Kepro generally takes initial action (approve, reject or wait for additional information) within five business days of receipt and for an ITP within 10 business days of receipt.

If additional information is required, Kepro will put the matter on hold for at least 15 working days. If Kepro determines that a matter is pending, Kepro will generally take final action within three working days of Kepro receiving all requested information, or 15 business days after the complaint is filed if Kepro does not receive a response. 3. U.S. Postal Service: Submit the appropriate ADA dental claim form along with all required clinical support documents and a recent copy of X-rays. Retrospective Review of Medical Need If the service began without the GCSP determining the medical necessity and the TPL coverage ends, the CMHP will only pay for the remainder of the service if the applicable eligibility criteria were met at the start of the service. Request a retroactive verification of the authorization. Paragon`s vision of Know-how, which invites those who believe in strong partnerships and want to avoid unexpected and crippling healthcare costs, makes many aware of the immense importance of collaboration while maximizing the latest technologies that bring even more clarity to this ever-changing industry. Today, Paragon`s customers experience first-hand the cost-effective and undeniable benefits of collaborating and making all future healthcare decisions based on statistical data and information. Emergency Medical Assistance (EMA) Care Plan (CPC) Certification Note: If you use Kepro Atrezzo`s provider portal to submit the original authorization request, you do not need to submit the request with MN-ITS. With the exception of emergency services, providers providing health services to MHCP members outside of Minnesota or its local commercial territory must obtain approval before providing MHCP-covered services.

Out-of-state providers who do not see the member but provide health services (for example, laboratory or medical care) do not need to obtain approval unless the services would otherwise require approval. Use the secure Kepro Atrezzo online provider portal from the Kepro website ( to download and submit the EMA-CPC application and the required accompanying clinical documentation. Visit Kepro`s website for training on how to upload documents through the Atrezzo supplier portal. Providers do not have the right to appeal a licence application that has been rejected under the MHCP`s fair hearing process. Providers may submit additional documentation and ask the medical investigator to review a decision. Authorization Review Agents use the criteria listed below when processing authorization requests. Submit documentation showing that the service requested is: If the examiner or MHCP refuses or reduces an approval, the member may appeal the decision for cause within 30 days or 90 days (see Your Appeal Rights [DHS-1941] [PDF]) and receive a hearing before a DUS adjudicator.