Service to Prior Authorization Flow Chart (Utilization Management Process)

Flowchart text

1. ISP Team meeting held. Services to support individual determined by the team
2. 30 days prior to effective date of ISP, Service Coordinator submits service requests to DDA waiver unit
3. For timely approvals, all required documents must be present at the time of service request to DDA waiver unit.
4. DDA Waiver Unit reviews all request to ensure all request meet service rule criteria
5. Services are approved by DDA waiver unit. Provider will recieve a Service Authorization (SA) Service Authorization from DDS is the GREEN LIGHTto Provide Services
6. Provider receives Service Authorization Provider must check SA to ensure accuracy
   • If SA is correct, proceed to #7
   • If incorrect, see Billing/PA Technical Assistance Guide
7. All DDA approved services are sent to Delmarva
8. Delmarva generates Prior Authorization numbers (PA#'s) (takes about 5-7 business days to process)
9. Delmarva process all PA#'s and inputs into MMIS
10. ACS generates Remittance letter and sends to Provider
    • If DDA SA and ACS PA does not match, Do not Bill
    • See Billing PA Technical Assistance Guide

Provider Bills Successfully!