1. What if I don’t have all of the clinical documentation at the time of making the non-Medicaid authorization request?
A provider can still request a “pre-authorization” without all the completed clinical documentation, though the status of the auth request would be considered “incomplete”, while “pending authorization review”, until all required documents are received and the ASO has reviewed and made a final determination.
2. What if I don’t know the individual’s income and our agency cannot obtain that information?
The ASO has limited resources. The ASO has income eligibility requirements for certain funding sources to pay for voluntary services being requested. Please check your agencies policy and procedures, desk references, or protocols on how individual eligibility verification takes place and what steps are taken when the agency cannot obtain information to verify income. Additionally, please refer to the ASO 6019 Medicaid Eligibility Verification and 6033 Non-Medicaid Services, General Fund State, & Federal Block Grant policy and procedures on our website, grbhaso.org, for more information. Therefore, the ASO does need the agencies to perform this step for us to determine if the services being requested can be paid for. It is acceptable for the agency to include as part of the income verification process after the agency exhausted all attempts (these attempts should be documented) to receive a written client statement about their income situation. This would be considered as a self-report.
3. Can any agency fill out the non-Medicaid request form?
Any behavioral health provider in the State of Washington can fill out the request to authorize behavioral health treatment services.
4. Who should be filling out the non-Medicaid request form?
The agency/provider that is providing the treatment services directly to the individual is the one that should be filling out the request.
5. Is there a limit to how many times someone can request authorization from Great Rivers BH-ASO?
No, there is no limit to how many times someone can request authorization from Great Rivers BH-ASO, but it is expected that the provider would collaborate with the ASO regarding possible over-utilization and provide adequate care coordination for individuals.
6. How long does it take to get notice of an approval or denial?
Please reference the ASOs Policy No. 6000 Utilization Management Requirements, in the “Timeframes for Authorization Decisions”, section, 3.10.
7. What if the individual would “likely” qualify for Medicaid, but they refuse to sign up for Medicaid?
The ASO has limited resources. The ASO has income eligibility requirements for certain funding sources to pay for voluntary services being requested. Please check your agencies policy and procedures, desk references, or protocols on how individual eligibility verification takes place and what steps agencies take to assist the individual in obtaining certain public health insurance coverage such as Medicaid, Medicare, Veterans, etc. Additionally, please refer to the ASO 6019 Medicaid Eligibility Verification and 6033 Non-Medicaid Services, General Fund State, & Federal Block Grant policy and procedures on our website, grbhaso.org, for more information. We encourage continued attempts as appropriate, as this funding is limited. The attempts should be a part of the process and documented when requested to ASO to pay for the services.
8. Does the request for authorization have to be for “recent” services?
For post-service or retrospective authorization reviews, the service dates must be during the current fiscal year which starts July 1st. Any requests for authorization prior to July 1st will be denied as current funding cannot pay for previous fiscal year.