Effective for vision services performed on or after July 1, 2006, the Payment Request For Vision Care and Appliances (45-1) claim form will no longer be used to request prior authorization for medically necessary contact lenses, low vision aids, and other non-PIA covered items.

Instead of the 45-1 claim form, providers will be required to use the TAR (50-3) form to submit prior authorization requests for eye appliances services performed on or after July 1, 2006. A draft of this form is included with this bulletin.

The TAR (50-3) form is available and can be ordered by contacting the Telephone Service Center (TSC) at 1-800-541-5555. However, the TAR (50-3) form cannot be used to request authorization for any service performed prior to July 1, 2006. Please continue to follow current procedures using the 45-1 claim form to request prior authorization for dates of service prior to July 1, 2006.

New Authorization Process
The current authorization process requires that an original 45-1 claim form be mailed to the Vision Care Policy Unit (VCPU) for authorization. Effective for vision services performed on or after July 1, 2006, the TAR (50-3) form and associated documentation can be mailed or faxed to:

Department of Health Care Services
Vision Care Policy Unit
MS 4600
P.O. Box 997413
Sacramento, CA 95899-7413

VCPU Fax Number: (916) 440-5640

Since this new TAR process allows the provider the ability to submit and receive the TAR (50-3) by fax, it will improve the response and turnaround time for authorizations.

Upon completion of the authorization review process, the VCPU will fax (if a valid fax number is included on the form) or mail the TAR (50-3) form back with a decision (Approved as Requested, Approved as Modified, Denied, or Deferred). All TARs are assigned a TAR Control Number (TCN) and Pricing Indicator (PI) on the 50-3 form. Claims for approved services must include a valid TCN and PI for payment. The assigned TCN and PI are also required for resubmission of deferred TARs.

Specific instructions about how to use the TAR (50-3) form and how to submit claims of approved services for payment will be addressed at Medi-Cal instructor-led seminars and future Medi-Cal Updates. For a schedule of upcoming seminars, please call the TSC or visit the Medi-Cal Instructor-Led Seminars page of the Medi-Cal Web site.

New Treatment Authorization Request (50-3) Form