Medical Authorization Unit - Medical Unit

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Welcome to the Medical Authorization webpage. This information is designed to assist the providers with submitting prior authorization requests (PAR) correctly the first time. The goal of MAU is to streamline the PAR process while maintaining compliance with OHCA, state and federal policy and rules. Please sign on to WEB ALERTS to receive email notifications when changes are made to this web page.

NOTICE:  Effective 7/1/2017, all initial (new) PARs must be initiated using the Sooner Care Provider Portal, including the upload of supporting clinical documentation. All PA’s sent by providers via fax or mail will be returned – see Provider Letter 2017-07.


PA’s Processed by the SoonerCare Medical Authorization Unit – Medical Unit

PA’s Processed by other SoonerCare Units and Outside Agencies and Vendors

Resources

PA Status Explanations

PA Status
PA Explanation
Approved    
Line has met the medical necessity and been approved.
PAs are not a guarantee of payment due to a variety of
reasons such as eligibility, etc.
Denied     
Line is denied by a consultant or physician as not being
medically necessary based on the documentation submitted.
Evaluation
Line is currently waiting to be reviewed by MAU staff
Pending Line is Pending to the next level of review
Pending
Documents     
Line has been pended back to the provider who
submitted the request to obtain additional documentation -
Remarks section in the PA on the Provider Portal will indicate 
to the provider what is needed. Provider will have 10 days
to submit the requested information  
System
Cancelled     
      
Line is cancelled by the system for various reasons such as
Non Covered Services, No Eligibility, Medicare Primary, No 
Documents submitted for review, Requested Documentation
not received, etc.