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• Request an appeal, • Confirm eligibility, • Verify coverage, • Ask whether a service requires pri- or authorization, or


• Request an out-of-network referral. Rather, Ms. Brewer says, the efforts


bring at least some standardization to what’s already required of practices during the preauthorization process. The agency coalesced and con-


sidered existing prior authorization forms used by plans, including Med- icaid, as well as national standards, and looked at other state models for uniform precertification forms. The final products, she says, give practices a simple way to initiate the preautho- rization process; identify the patient and procedure or drug requested; and if needed, attach any additional medi- cal documentation insurers might re- quire as part of their approval criteria.


NEXT: ELECTRONIC VERSION Drs. Levy and Sheppard also empha- sized that the project was just the be- ginning of what they anticipate will be ongoing discussions to create a stan- dard form that eventually practices can file electronically. “That’s where the real savings are


for practices because then a lot of this can be done without using the phone and waiting,” Dr. Levy said. “The legislature only required a writ- ten form, and that’s what we did. But this will be the basis for what we can do electronically to allowall practices to obtain this information easily and quickly.” In formatting the prescription drug form, for example, Dr. Sheppard adds


All articles in Texas Medicine that mention Texas Medical Association’s stance on state legislation are defined as “legislative advertising,” according to Texas Govt. Code Ann. §305.027. That law requires disclosure of the name and address of the person who contracts with the printer to publish the legislative advertising in Texas Medicine: Louis J. Goodman, PhD, Executive Vice President, TMA, 401 W. 15th St., Austin, TX 78701.


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March 2015 TEXAS MEDICINE 33


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