November 8, 2019

An update to the Clinical Prior Authorization Assistance Chart (PDF) is available.

There are certain clinical prior authorizations that all MCOs are required to perform. Usage of other clinical prior authorizations will vary between health plans at the discretion of each MCO. The published criteria guide for each prior authorization describes how authorization requests are evaluated:

  • All steps from the criteria guide apply to traditional Medicaid claims processed by VDP
  • This assistance chart identifies which prior authorizations are utilized by each MCO and how those prior authorizations relate to those used by VDP

For more information about each MCO’s clinical prior authorization requirements, providers can: