Appendix 12 — Prior Authorization Fax Procedures
Providers may fax prior authorization (PA) requests to Wisconsin Medicaid at (608) 221-8616. Prior authorization requests sent to any Wisconsin Medicaid fax number other than (608) 221-8616 may result in processing delays.
When faxing PA requests to Wisconsin Medicaid, providers should be aware of the following:
Include a Fax Transmittal Cover Letter
Include a completed fax transmittal cover letter that includes the following:
- Date of the fax transmission.
- Number of pages including the cover sheet. The Medicaid fax clerk will contact the provider by fax or telephone if all the pages do not transmit. (Refer to the following section for instructions if all the pages do not transmit.)
- Provider contact person and telephone number. The Wisconsin Medicaid fax clerk may contact the provider with any questions about the fax transmission.
- Wisconsin Medicaid provider identification number.
- Fax number to which Wisconsin Medicaid may send its adjudication decision.
- To: "Wisconsin Medicaid Prior Authorization."
- Wisconsin Medicaid’s fax number ([608] 221-8616). Prior authorization requests sent to any other Wisconsin Medicaid fax number may result in processing delays.
- Wisconsin Medicaid’s telephone numbers. For specific PA questions, providers should call (800) 947-9627 or (608) 221-9883. For faxing questions, providers should call (608) 221-4746, extension 3064*.
*Extension 3064 is no longer valid. Please use extension 80118, effective immediately.
Incomplete Fax Transmissions
If all the pages listed on the initial cover sheet do not transmit (i.e., pages have stuck together, the fax machine has jammed, or some other error has stopped the fax transmission) or if the PA request is missing information, providers will receive the following by fax from the Medicaid fax clerk:
- A cover sheet explaining why the PA request is being returned.
- Part or all of the original incomplete fax that Medicaid received.
If a PA request is returned to the provider due to faxing problems, providers should:
- Attach a completed cover sheet with the number of pages of the fax.
- Resend the entire original fax transmission and the additional information requested by the fax clerk to (608) 221-8616.
General Guidelines
When faxing information to Wisconsin Medicaid, providers should not reduce the size of the Prior Authorization Request Form (PA/RF) to fit on the bottom half of the cover page. This makes the PA request difficult to read and leaves no space for consultants to write a response if needed or to sign the request.
If a photocopy of the original PA request and attachments is faxed, the provider should make sure these copies are clear and legible. If the information is not clear, it will be returned to the provider.
If the provider does not indicate his or her fax number, Wisconsin Medicaid will mail the decision back to the provider.
Wisconsin Medicaid will attempt to fax the PA request to a provider three times. If unsuccessful, the PA request will be mailed to the provider.
If providers are not sure if an entire fax was sent, they should call Medicaid’s fax clerk at (608) 221-4746, extension 3064*, to check the status of the fax.
*Extension 3064 is no longer valid. Please use extension 80118, effective immediately.
Prior Authorization Request Deadlines
Faxing a PA request eliminates one to three days of mail time. However, the adjudication time of the PA request has not changed. All actions regarding PA requests are made within the time frames outlined in the Prior Authorization section of the All-Provider Handbook.
Faxed PA requests must be received by 1:00 p.m., otherwise they will be considered received as of the following business day. Faxed PA requests received on Saturday or Sunday will be processed on the next business day.
Avoid Duplicating Prior Authorization Requests
After faxing a PA request, providers should not send the original paperwork, such as the carbon PA/RF, by mail. Mailing the original paperwork after faxing the PA request will create duplicate PA requests in the system and may result in a delay of several days to process the faxed PA request.
Refaxing a PA request before the previous PA request has been returned will create duplicate PA requests and may result in delays.
Submitting New Prior Authorization Requests
Providers should not photocopy and reuse the same PA/RF for other requests. When submitting a new request for PA, it must be submitted on a new PA/RF so that the request is processed under a new PA number. This requirement applies whether the PA request is submitted by fax or by mail.
Resubmitting Prior Authorization Requests
When resubmitting a faxed PA request, providers are required to resubmit the faxed copy of the PA request, including attachments, which includes Wisconsin Medicaid’s 15-digit internal control number located on the top half of the PA/RF. This will allow the provider to obtain the earliest possible grant date for the PA request (apart from backdating for retroactive eligibility). If any attachments or additional information that was requested is received without the rest of the PA request, the information will be returned to the provider.
For More Information
Refer to the Prior Authorization section of the All-Provider Handbook for information on responses to PA requests and how to amend them.
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Chiropractic Services Handbook
PHC 1306, October 2004