Some of you may be wondering what a prior authorization is and what items fall under that category. A prior authorization is required for an item that the Department of Labor (DOL) needs documentation showing why it is medically necessary for you to have it before it can be sent to you. These are normally more expensive items such as oxygen concentrators, lift chairs, hospital beds, wheelchairs, and power scooters. We here on the EWMS Prior Authorizations Team work to make the process of getting those items approved easier for you.
What the DOL needs in order to review the medical need of a prior authorization item is:
- A Letter of Medical Necessity signed by your Physician. This must come from a MD or a DO, the Department of Labor will not accept any other medical title on the physician’s signature.
- A Prescription signed by the same Physician as the Letter of Medical Necessity (must be a MD or DO as well)
- The most recent office visit notes. The DOL likes the office visit to have happened within the last six months and reflect, if possible, the conversation of the item being requested.
Oxygen concentrators (stationary and portable) are a bit different than the other items. They require that an oxygen test has been performed within the last six months. The DOL will accept Pulmonary Function Test (PFT), Spirometry, Arterial Blood Gas (ABG), or an Overnight Pulse Oximetry Test. A 6-minute walk test is NOT considered sufficient to prove medical necessity according to the DOL guidelines. Now not all of this has to come from your doctor’s office. If you or your Home Health Company have any of the office visit notes or tests in files that you have for personal use send them our way! That is one less thing that we will have to request from your already busy doctors and it lightens their load of paperwork they need to gather.
Once EWMS receives all the paperwork we then can prepare the authorization and get it sent over to The Department of Labor. There is a new and updated website that allows us to upload and submit to the DOL online. However, the DOL is still taking the usual 6 to 8 weeks for a prior authorization to get approved. If you are needing an item before that 6 to 8-week period give your DOL Examiner a call and let them know. Doing that puts you and your request on their radar and can lead to a swifter approval, no guarantees though.
That is the Energy Workers Medical Services Prior Authorization Process! We love serving you and are grateful for each and everyone of our customers because without you there would be no EWMS.