Is the CMO responsible for reviewing, approving, denying, and modifying mental health PA requests?
Yes, the CMOs are responsible for PA request processing, utilization review, reporting, and network development for all medical and behavioral health services covered under the program, with the exception of pharmacy. PA requests for behavioral health drugs (just like other prescription drugs) fall under the pharmacy carve-out, which is handled by ACS-a Xerox Company, the State’s pharmacy benefit manager. HP continues to be the entity responsible for claims processing for all claim types.
