405 IAC 5-3-11 Criteria for prior authorization

Sec. 11. The office's decision to authorize, modify, or deny a given request for prior authorization shall include consideration of the following: (1) Individual case-by-case review of the completed Medicaid prior authorization request form. (2) The medical and social information provided on the request form or documentation accompanying the request form. (3) Review of criteria set out in this section for the service requested. (4) If the service is medically necessary as defined in this article.