Quick Authorization Form (QAF)

For those services included on the SHP Quick Authorization Form (QAF) (see the Forms Section of this handbook) a referral is NOT required. Primary Care Physicians (PCP’s) can refer a member to a  participating specialist and to many frequently requested services and procedures at free-standing facilities with the Simply Healthcare Plans Quick Authorization Form (QAF) without contacting the health plan for prior authorization.

IMPORTANT NOTE: Communication with the Plan prior to the provision of care is not necessary when using the QAF; however, all inpatient services, outpatient hospital services (including diagnostics), and ASC services do require an authorization

Prenatal care referrals are NOT to be made using the QAF.

**The QAF form is not valid for any inpatient or outpatient hospital services or for any
consultations or procedures not listed on the form, or for out-of-network providers.**

The PCP or specialist ordering the consultation or test is required to fax or mail a copy of the
completed QAF to the participating provider or facility that will be providing the service(s), or
to give a copy to the member so that it is presented at the time of the service


Services that Do NOT Require Prior Authorization or QAF:

 Family Planning*
 Participating Office/free standing laboratory tests at labs consistent with CLIA guidelines
 Emergent transportation services
 Urgent or emergent care at participating Urgent Care centers or any Emergency Room
 County Health Departments (CHD), Federally Qualified Health Centers , Rural Health Clinics and
federally funded migrant health centers when providing:
 Vaccines
 STD diagnosis/treatment
 Rabies diagnosis/immunization
 Family planning services and related pharmaceuticals
 School health services and urgent services

*NOTE: If the member receives Family Planning Services from a non-network Medicaid
provider, the Plan will reimburse the provider at the Medicaid reimbursement rate, unless
another payment rate is negotiated.

No comments:

Medical Billing Popular Articles