The following Service to Prior Authorization Flow Chart (Utilization Management Process) is available as a PDF document:
- ISP Team meeting held. Services to support individual determined by the team
- 30 days prior to effective date of ISP, Service Coordinator submits service requests to DDA waiver unit
- For timely approvals, all required documents must be present at the time of service request to DDA waiver unit.
- DDA Waiver Unit reviews all request to ensure all request meet service rule criteria
- Services are approved by DDA waiver unit. Provider will receive a Service Authorization (SA) Service Authorization from DDS is the GREEN LIGHT to Provide Services
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
- All DDA approved services are sent to Delmarva
- Delmarva generates Prior Authorization numbers (PA#'s) (takes about 5-7 business days to process)
- Delmarva process all PA#'s and inputs into MMIS
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!