Prior authorization requests are returned to providers for both clerical and clinical reasons. The required attachments have not been filled out correctly or are not included with PA requests. The physician's orders do not list required services in hours per day and days per week. The billing provider's name, address, or Wisconsin Medicaid provider number is missing or incorrect. The recipient is not eligible for Wisconsin Medicaid on the date Medicaid receives the PA request.
Prior authorization is always contingent upon the recipient's eligibility on the date of service.
The recipient's name or the Wisconsin Medicaid identification number on the PA request does not match the name on file for the given Medicaid number. Be sure to use the recipient name and Medicaid identification number exactly as they appear on the Medicaid identification card. Clinical information supplied on the PA attachment was not detailed enough to verify the medical necessity for the requested service. Clinical information is outdated. There is discrepancy from previous PAs or PAs submitted by other disciplines and providers.