AUTHORIZATIONS

Referral Authorizations

AMM can receive referral authorizations requests directly from participating Primary Care Physicians on-line. PCPs can complete the website form with the convenience of pull down enrollment lists, CPT codes, ICD-9 codes, and contracted specialist’s lists. The submitted referral request has a permanent tracking number assigned instantly and the request automatically updates the EZ-CAP database at AMM. If auto approval rules are determined by the IPA Medical Director and UM Committee, then AMM can program Cerecons to automatically approve authorizations submitted online that meet those specific criteria. IPA providers must comply with certain minimum computer hardware and software specifications and generate sufficient referral request volume.

AMM has a referral authorization process in place that consistently generates 24 to 48- hour turnaround for routine requests and stat or urgent turnaround in two to four hours. This process requires PCP offices to log into a secure website to enter their referral requests. Stat, urgent, auto approved authorizations and other fast track protocols can be programmed into the process for expedited turnaround.

Each day's totals are statistically reconciled to the member letters so that all requests are accounted for. Deferred requests are tracked and letters notifying members of each approved and denied request are mailed to members daily. Weekly reports are mailed to health plans as required individually. Weekly Utilization logs are generated for the IPA Utilization Committee as well as denial logs, and any custom programmed reports. As mentioned above, PCP’s, Specialty Providers, IPA Officers and the Medical Director have real time access to Cerecons authorization data.