California
§ 51003.7. Prior Authorization Under Primary Care Case Management Contracts.
1 provisions · California regulatory authority
Provisions
Citable source units
22 CCR 51003.7Reimbursement PaymentProgram Integrity Fraud Abuse
Prior Authorization Under Primary Care Case Management Contracts.
Requires prior authorization for specified Medi-Cal services under PCCM contracts, limits payment for unauthorized services, provides for recoupment, and governs physician delegation of authorization duties.
Group
Payment Program Integrity
Category
Reimbursement Payment
Domain
Billing Reimbursement
Topics
PCCM prior authorization, Medi Cal payment recoupment, Physician authorization delegation
Taxonomy
Regulatory category mix