An update to the Clinical Prior Authorization Assistance Chart is available.
HHSC requires MCOs to implement specific clinical prior authorizations for clients enrolled in managed care. Usage of other clinical prior authorizations will vary between MCOs at the discretion of each MCO.
HHSC publishes a criteria guide for each prior authorization with a description of the steps in the evaluation process. All steps apply to traditional Medicaid claims processed by HHSC. The assistance chart identifies which clinical prior authorization each MCO uses and whether the MCO uses all or some of the steps in the evaluation process.
Refer to the MCO Resource Information for the prior authorization call center phone number unique to each MCO and a link to each MCO’s active clinical prior authorizations and clinical prior authorization requirements.