Is prior authorization required on a service provided when the hospital is an out-of-state facility? How does the out-of-state facility bill?
Response: Prior authorization is not required by an out-of-state facility when services are provided in accordance with Regulation 1163.65. Out-of-state facilities will need to obtain a Budget Limit Approval for inpatient hospital stays that exceed the Budget Limits established. For questions related to services provided and billing, call the Practitioner Inquiry Lines at 1-800-537-8862. Prior authorization is now required for “nonemergent/urgent Out of State Services” as per Place of Service Review Procedures on MAB 01-06-01; 02-06-01; 14-06-01; 31-06-01; 27-06-02.
Related Questions
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