Effective October 4, as part of the AmeriHealth Caritas Appian deployment to connect Appian and the Prior Authorization lookup tool, there is a new message in the tool.
- If a code is not on Ohio Department of Medicaid's (ODM) fee schedule, this message will appear:
- This code is not on the Ohio State Medicaid Fee Schedule and prior authorization is required. Please submit your request with supporting clinical documentation through NaviNet (https://navinet.navimedix.com).
- If the code is on ODM's fee schedule, the appropriate message will populate.
- The fee schedule check is against Facets and is the same function that is used in the rule engine for decisioning. Thus, the fee schedule updates are as frequent as they are updated in Facets.
