Processing Changes for Treatment Authorization Requests (TARs)

Beginning May 1, 2007, the California Department of Health Services (DHCS) will phase in several changes which will impact how paper Treatment Authorization Requests (TARs) are processed.

These changes are being implemented to minimize the key data entry of incomplete or erroneous TAR information and to reduce the volume of paper documents containing Protected Health Information (PHI), particularly Social Security Numbers (SSNs) that are sent via:

• United States Postal Service
• Courier services
• Other types of delivery services

DHCS expects to complete this phased implementation by September 2007.

Processing Change Schedule
Processing changes to paper TARs will impact providers interacting with the Medi-Cal field offices and pharmacy sections on the following dates:

May 2007 Sacramento Medi-Cal Field Office	June 2007 Northern Pharmacy Section (Stockton) Southern Pharmacy Section (Los Angeles)
July 2007 Los Angeles Medi-Cal Field Office In-Home Operations South	August 2007 San Francisco Medi-Cal Field Office San Diego Medi-Cal Field Office
August 2007 Fresno Medi-Cal Field Office San Bernardino Medi-Cal Field Office	September 2007 TAR Administrative Remedy Section In-Home Operations North

Incomplete TARs
DHCS Medi-Cal field offices and pharmacy sections will be unable to enter paper TARs with incomplete information into the TAR system. These paper TARs will be deferred back to the submitting provider, with a Medi-Cal field office/pharmacy section Incomplete TAR Form identifying the reasons for deferral and instructions about how to resubmit the paper TAR with the necessary corrections.

Providers are to:

• Make the necessary corrections/changes on the paper TAR, and
• Resubmit with a copy of the Incomplete TAR Form on top of the paper TAR.

Paper TARs that are returned to the submitting provider for correction will not be available for inquiry through the Provider Telecommunications Network (PTN).

Any one of the reasons below will not allow the paper TAR information to be entered into the system. The reason(s) will be marked on the Incomplete TAR Form and sent back to the submitting provider for corrections. These reasons may consist of one or more of the following:

• The TAR form is illegible or damaged.
• The submitting provider number is missing, inactive, suspended or invalid for the category of service requested.
• The patient’s Medi-Cal ID number is missing, invalid or invalid in length, and the patient’s name/date of birth is missing.
• The patient is not Medi-Cal eligible.
• Information in the Admit From field (Box 14) on the Long Term Care Treatment Authorization Request (LTC TAR, form 20-1) is missing or invalid.
• The requested service information is missing, invalid or invalid in length.
• The ICD-9-CM diagnosis code, admitting ICD-9-CM diagnosis code and/or primary DX diagnosis code is missing or invalid.
• The County Medical Services Program (CMSP) pharmacy services are covered by MEDIMPACT. Please call
  1-800-788-2949 for further information.
• The requested Adult Day Health Care (ADHC) service should specify the months and the number of requested days for each calendar month on separate lines of the TAR. The TAR request should not exceed six months or have more than one service line for a given calendar month. Please refer to the appropriate Part 2 manual for specific TAR preparation instructions.

Adjudication Response
DHCS will discontinue the practice of returning adjudicated paper TAR copies to providers based on the schedule above. Instead, providers will receive an Adjudication Response (AR), which will display:

• The status of requested service(s)
• The reason(s) for the decision(s), including TAR decisions resulting from an approved or modified appeal
• The adjudicator’s request for additional information, if necessary

The AR will enable the provider to respond to the requested information or proceed to bill for authorized services. (See the Adjudication Response example.) Providers should keep a copy of the AR for their records and use it when responding to deferrals or when requesting an update/correction to a previously approved or modified TAR.

When requesting an update/correction, a copy of the AR must be placed on top of newly submitted documents to ensure the information can be matched with previously submitted documentation. Providers should clearly specify what change(s) are being requested.

ARs will be mailed to the provider’s address on file with DHCS’ Payment Systems Division, Provider Enrollment Branch (PEB). Providers should ensure PEB has their most up-to-date mailing address on file. Instructions about changing/updating a provider address may be found on the Provider Enrollment Branch (PEB) page.

Attachments
On November 15, 2006, DHCS notified providers via a flyer that attachments were no longer being returned with deferred paper TARs. Medi-Cal field offices and pharmacy sections will continue to retain and archive all attachments for reference.

Providers responding to a deferred TAR should return the AR and any new attachment(s) requested.

SSN on TARs
In accordance with Medi-Cal Updates issued in August and September 2006, providers should use the recipient’s Benefits Identification Card (BIC) number on the TAR, rather than the SSN. If a TAR is returned to a provider because of inaccurate and/or incomplete information, the SSN will be removed.

If you have any questions regarding this information, please contact your local Medi-Cal field office or pharmacy section.

National Provider Identifier (NPI) Number
Providers should be aware that the NPI number will not be accepted on TARs until after the official NPI implementation date of November 26, 2007. For detailed information about the new NPI implementation date, providers can view the Important NPI Time Frame Changes article posted in the “HIPAA News” area of the Medi-Cal Web site.

TARs issued under the old provider number (legacy number) prior to November 26, 2007 can still be used for claims submitted with an NPI starting on or after November 26, 2007. Providers will not have to request an updated TAR with the NPI information.