curative 240110 Onboarding Partners User Guide

curative 240110 Onboarding Partners

Product Information

Specifications:

• Version: V3 | January 2024
• Effective Date: September 2022

Product Usage Instructions

Overview:

The product is designed to assist with prior authorization or notification requirements for a wide range of medical services including advanced imaging, hospital admissions, rehabilitation facilities, hospice care, and more.

Step-by-Step Guide:

Prior Authorization Requirements:

1. Identify the specific medical service or procedure that requires prior authorization.
2. Contact Curative or PBM at 888-647-8741 to inquire about the authorization process.
3. Provide all necessary information and documentation as requested for the authorization.
4. Wait for confirmation of the authorization before proceeding with the medical service or procedure.

Notification Requirements:

1. For services that require notification to Curative, ensure that notifications are submitted within the specified time frame.
2. Include relevant details such as delivery information, mastectomy procedures, or hospice admissions.
3. Verify receipt of the notification by Curative for confirmation.

Frequently Asked Questions

• Q: How do I know if a specific medical service or procedure requires prior authorization?
  • A: Please refer to the detailed list provided in the user manual for specific services that require prior authorization. You can also contact Curative or PBM for assistance.
• Q: What should I do if I have questions about pharmacy prior authorization requirements?
  • A: For details about pharmacy prior authorization requirements, please contact Curative or PBM at 888-647-8741 for further clarification and guidance.

Prior Authorization or Notification Requirements

Service

| ****

Prior Authorization or Notification Requirements

---|---
Advanced Imaging (CT, MRI/MRA, PET, Nuclear studies)| Requires prior authorization.
All Inpatient Hospital Admissions

➔    Acute Hospital

➔    Acute Rehab Facilities

➔    Hospice

➔    Long Term Acute Care Facility (LTAC)

➔    Skilled Nursing Facility (SNF)

➔     Residential Treatment Center

| ****

Requires prior authorizations except as referenced below for Notifications.

Requires Notifications to Curative for Delivery, Mastectomy and Hospice admissions within 48 hours.

All Outpatient Surgical Procedures performed in a

hospital or free standing surgery center

| Requires prior authorization.
Applied Behavioral Analysis| Requires prior authorization.
Assistant Surgeon| Requires prior authorization.
Biofeedback for Urinary Incontinence (Biofeedback is not covered for other indications)| Requires prior authorization.
Cardiology – All Tests and Procedures| Requires prior authorization, except the following procedures:

➔    EKG including interpretation and leads – CPT codes 93000, 93010 and A4556

➔    Treadmill Tests – CPT codes 93016 and 93018

➔    Pacemaker Checks – CPT codes 93288

Cochlear Implant| Requires prior authorization.
Dialysis| Requires prior authorization.
Drugs listed on the Pharmacy Prior Authorization Listing| Requires prior authorization.
Any Durable Medical Equipment (DME)| Requires prior authorization for over $750 in billed charges.
Gender Affirmation Surgery and Treatment| Requires prior authorization.
Molecular Genetic Lab Testing| Requires prior authorization.
Home Health Care| Requires prior authorization.
Hospice Care| Requires prior authorization.
Hyperbaric Therapy| Requires prior authorization.
Formula /Food Products / Liquid Nutrition| Requires prior authorization.
Joint and Spine Surgery| Requires prior authorization
MOHS Procedures (performed in office or facility)| Requires prior authorization.
Non-Emergency Ambulance| Requires prior authorization.
Obesity Treatment| Requires prior authorization.
Observation| Requires Notification.
Oncology Services

➔    Chemotherapy

➔    Radiation Therapy

| Requires prior authorization.
Oral Surgery (performed in office or facility)| Requires prior authorization.
Orthotics and Prosthetics| Requires prior authorization.
Outpatient treatment of behavioral health care, substance use disorder and serious mental illness:

➔    Electroconvulsive therapy

➔    Partial Hospitalization

| Requires prior authorization.
➔    Intensive outpatient program|
---|---
Psychological / Neuropsychological Testing| Requires prior authorization.
Rehabilitative Services

➔    Physical Therapy

➔    Occupational Therapy

| Requires prior authorization.
Speech Therapy| Requires prior authorization.
Pain Management| Requires prior authorization.
Palliative Care| Requires prior authorization.
Prescription drugs (see list for drugs that apply for prior authorizations)| For details about pharmacy prior authorization requirements, please contact Curative or PBM at 888-647-8741.
Radiation Therapy / Radiation Oncology| Requires prior authorization.
Reconstructive Surgery & Procedures| Requires prior authorization.
Skilled nursing care in a skilled nursing facility| Requires prior authorization.
Sleep Study| Requires prior authorization.
Transplants| Requires prior authorization.

• Prior Authorization Form: Curative accepts the Texas Standard Prior Authorization Request Form in lieu of the Curative Prior Authorization Form.
• The Curative Prior Authorization is available to be completed through the Form by calling Curative Provider Service at 855-414-1083 or Curative Clinical Care Management at 855-414-1089

Prior Authorization Form

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