FOR MMCP: All Out-of-Network services and all services indicated below require authorization
FOR MCHP: Only the services indicated below require authorization
For services that require authorization, all MHN contracted providers must request authorization electronically as follows:
Non-participating providers should use our Authorization Request Form
For questions about requesting authorization electronically, please contact CCP at PlanLink@ccpcares.org. We would be happy to help you.
Admission Inpatient | |
---|---|
Elective Surgical Inpatient Admission | Elective Medical Inpatient Admission |
Non-elective (Emergency) Admission | Inpatient Rehabilitation Admission |
Skilled Nursing Facility Admission |
Admission Observation | |
---|---|
Hospital Observation Services ( for any reason ) | Admission / Discharge Same Day |
Home Health | |
---|---|
Skilled Nursing Visits | Home Respiratory Therapy Visits |
Home Social Worker Visits | Home Health Aide Visits |
Physician Home Visits | Private Duty Nursing |
Personal Care Services |
Hospice | |
---|---|
Hospice Outpatient At Home / ALF / SNF | Hospice Inpatient |
Diagnostic and Lab Testing | |
---|---|
Cardiac Event Monitoring | CT Scan |
Cta and Calcium Scoring | Genetic Testing |
Growth Evaluation & Tx For Hormone Therapy | MRI |
MRA | PET Scan |
Sleep Study |
Durable Medical Equipment( medical and surgical supplies do not require authorization) | |
---|---|
Bone Growth Stimulator | Clinitron and Electric Beds |
CPAP and BIPAP Machines | Diabetic Shoes |
Custom Wheelchairs | Electric Wheelchairs / Scooters |
Wheelchair Accessories | Insulin Pumps and Supplies |
Enteral Nutrition | Patient Lifts |
Wound Vac Pumps |
Maternity | |
---|---|
Obstetrical Care— All Sonograms, Pre-natal Procedures and Delivery |
Nutritional Services | |
---|---|
Nutritional Consulting | Nutritional Supplements / Nutrition Formulas / Enteral Nutrition |
Orthotics And Prosthetics | |
---|---|
Custom Orthotics | Limb and Torso Prosthetics |
Prosthetic Custom Eye, Surfacing & Fitting |
Transportation | |
---|---|
Non-emergent Ambulance Services | Air Ambulance |
Invasive Procedures | |
---|---|
Capsule Endoscopy | Cesarean Delivery |
Chemodenerve Eccrine Glands | Circumcision (Auth Required If Age > 1 Year) |
Denervation | Epidural Injection for Lysis |
Epidural Injection for Pain | Hormone Pellet Implant |
Hyperbaric Treatment ( Wound Care Center only ) | Oral Arthroscopy |
Oral Splint | Oral Surgery |
Spider Vein Therapy | Spider Vein Therapy - Injection / Laser |
Total Disc Arthroplasty (Artificial Disc) | Virtual CT Colonoscopy |
Cosmetic / Plastic / Reconstructive Procedures | |
---|---|
Adjacent Tissue Transfer / Rearrangement / Repair | Bariatric Surgery |
Canthoplasty | Correction of Lid Retraction |
Dermatological Procedures | Eyelid, Excision and Repair |
Foot and Toes Reconstruction | Gastric Restrictive |
Gastric Restrictive, Port Component | Hand and Fingers Reconstruction |
Head ( skull, face, TMJ ) Reconstruction | Humerus and Elbow Reconstruction |
Keratoprosthesis | Knee, Arthroplasty, Total |
Lip, Repair | Mastectomy Proc / Repair, Reconstruction |
Mastoid Surgery Revision | Neck and Thorax Reconstruction |
Nose, Repair | Ocular Adnexa, Strabismus Surgery |
Palatoplasty for Cleft Palate | Pelvis and Hip Reconstruction |
Penile Repair | Skin Flaps and Grafts |
Testicular Prosthesis Insertion |
Transplant | |
---|---|
Amniotic Membrane | Bone- Autograft for Spine Surgery |
Bone Marrow | Cornea |
Eye | Heart |
Heart-Lung | Intestine |
Kidney | Liver |
Lung | Ovarian |
Pancreas | Pancreatic Islet Cells |
Peripheral Stem Cells | Skin |
Tissue |