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317:35-3-3.Prior authorization requirements
[Revised 1-01-01]
Requests for prior authorization of medical services should be submitted on Form MS-MA-5, Notification of Needed Medical Services, except for those specific forms indicated below. The MS-MA-5, the Prescription for Appliances, Prostheses and/or Medical Suppliers Request for Prior Authorization form, Hearing Appliance Prescription and Supplier Request for Prior Authorization form, and Request for Prior Authorization for Dental Services form, should be sent to OHCA, Medical Authorization Unit. The Medical authorization unit approves or disapproves each medical service. A computer generated prior Authorization Notice, Form MS-S-4, showing approval or denial of the service is mailed to the provider, client and county office. The MS-S-4, is not a notice of the individual's eligibility for Title XIX, and the approval may go beyond the period of eligibility.
(1) Adults and children. The following medical services require prior authorization by the OHCA, Special Health Care Needs, for all individuals:
(A) Purchase of oxygen systems, rental or purchase of ventilators, respirators, and hyperalimentation. Physician's Prescription for Appliances, Prostheses, and/or Medical Equipment and Medical Suppliers Request for Prior Authorization form must be completed by the physician and medical supplier.
(B) Dental services as indicated in the OHCA Medical Services Provider Manual. Services include limited oral surgery and treatment procedure and dental care for individuals receiving Intermediate Care Facility Services for the Mentally Retarded. Form MS-MA-5 and/or Request for Prior Authorization for Dental Services form must be completed by the dentist.
(C) Blood and blood fractions.
(D) Medical services rendered in behalf of Legalized, Illegal, and Ineligible Aliens. The provider must clearly indicate on the MS-MA-5 in Section III whether the service was rendered as an emergency.
(E) Adaptive equipment uniquely specialized for an individual=s needs (equipment, appliances and prosthetic devices) beyond the scope of the Title XIX program for individuals in Intermediate Care Facilities for the Mentally Retarded.
(2) Children. In addition to those services that are covered, when preauthorized, for all ages, the following medical services require prior authorization by the OHCA, Special Health Care Needs, for individuals under 21 years of age:
(A) Orthotic procedures listed by HCPC codes L5000 through L9999.
(B) Hearing aids. Form MS-MA-5 must be completed by the physician and the Hearing Appliance Prescription and Supplier Request for Prior Authorization form must be completed by the audiologist and supplier.
(C) Dental services requiring a treatment plan as indicated in OAC 317:30-5-695. Form MS-MA-5 and/or Request for Prior Authorization for Dental Services must be completed by the dentist.
(D) EPSDT services beyond the scope of Title XIX when identified by an EPSDT screening as necessary to correct or ameliorate defects and physical and mental illness and conditions.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.