Prestige Tips for Billing and Auths in 2019 (Part 2)

This article is Part 2 of our tips for Prestige Health Choice. If you haven’t already read Part 1, you might want to stop and do so. Part 2 will review Prestige Authorizations. Even if you’re a seasoned expert with Prestige, there are some tips that you might find helpful.  

Authorizations:

Issue (Auth Denials): If you’re new to submitting authorizations to Prestige, you’ve probably noticed that they review your requests a bit more thoroughly than other MMAs. This means that you are more likely to get a denial if they do not deem the services medically necessary. In fact, I’ve seen a lot of denials for authorizations asking for more than 2 visits per week as they automatically get reviewed by a medical director at Prestige. Many of these denials are unfounded and solely based on testing scores while ignoring the evaluator’s qualitative assessment. But once the service is denied or reduced, it can be burdensome and frustrating process to appeal and overturn their decision. The best way to avoid this is to write good reports. However, when good reports aren’t enough and your authorization still gets denied, it’s time to appeal.

Recommendation to fix: The quickest and most effective process for overturning a Prestige authorization denial is to fax two documents to the Prestige Authorization Denial Department at (855) 358-5853.

Document #1 is a correctly completed Prestige “Provider Appeal Form” which can be found for download at: https://www.prestigehealthchoice.com/pdf/provider/resources/provider-appeal-form.pdf

Document #2 is a qualitative/quantitative write-up of the evaluating therapist’s reasoning for requesting the appeal. Always best to put it on your company letterhead as well.

If you fax those documents to the number listed above, you will receive a response within 30 days to either overturn or uphold their original decision.

The last item I want to mention is a better process for submitting authorizations to Prestige. If you don’t already use their online submission tool, I highly recommend it. There is no better way to track your submissions and attach clinical updates as well as further requests for information. In addition, the information stays in the portal so you can always look it up later if you run into issues with authorizations (prestige is known to make mistakes). You can find this online tool on your Availity portal. From your Availity dashboard, select the “Prestige” icon from the “payor spaces” menu. Then click “resources” and select “Prestige Health Choice Authorization”. That will open a new window that takes you to the online tool powered by Jiva. The submission process is pretty straightforward and your submissions are recorded in a queue on your dashboard for reference.

I hope this helps improve your authorization experience with Prestige; they will deny auths more than other payors but they also have a clear process for appeals. As I’ve said before, they are actually one of the better Medicaid Payors to work with in Region 9.