Attachment Tips

When submitting attachments, providers should include all pertinent documentation that medically justifies why the service is needed. Here are some examples

• When requesting reauthorization for protective underwear (pull-on products), providers should include an updated prescription as well as an updated toilet training progress report. TARs will be deferred if these documents are not submitted.
• TARs that have line items (for example, creams and washes) included with other incontinence supply items, must include an Intermediate Care Facilities for the Developmentally Disabled (ICF-DD) residency validation. TARs without residency validation will be deferred due to optional benefits being excluded under the Medi-Cal program.
• Specific medical justification and documentation are needed to support products that meet the descriptions of non-contracted billing (HCPCS) codes and for amounts greater than the utilization limits for contracted billing (HCPCS) codes. (Examples of documentation include toilet training progress reports, bladder/bowel assessments, incontinent flow records, client care flow records). Medical diagnosis must be related to the bowel/bladder incontinence.
   

Miscellaneous TAR Information Section Tips

The Miscellaneous TAR Information field of eTAR allows providers to enter information that will medically justify the need of the TAR. Providers may enter up to 500 characters in this field.

• For retroactive eTARs, providers should ensure the "Requested From Date" and "Requested Thru Date" are entered.
• For non-contracted pediatric incontinence supplies, providers should include the recipient's height and weight, as well as a list of formulary products tried in the Miscellaneous TAR Information field. For non-contracted bariatric diapers, include waist size.
   

Incontinence Supply Information

• Claims for contracted billing (HCPCS) codes are restricted to items on the Incontinence Contracted Product List and require a TAR only if billing for quantities in excess of the quantity limitations.
• A TAR is required for all products that meet the descriptions for non-contracted billing (HCPCS) codes.
• TARs are only needed if the incontinence supplies exceed $165 per month.
• When requesting an incontinence supply for creams and washes, providers should enter the amount in milliliters or grams in the Units of Service field and verify the amounts with the prescription. If the beneficiary is not residing in an ICF-DD or is not on the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, these are optional benefits that are excluded under the Medi-Cal program.
• Medi-Cal may reimburse for incontinence supplies through EPSDT benefits where the incontinence is due to a chronic physical or mental condition.
• Contracted protective underwear (pull-on) products are restricted to items on the Incontinence Contracted Products List for patients weighing more than 80 lbs.
• For clients at home or in board and care, providers should submit TARs only for the amount greater than the $165 per month allowance and/or over the utilization limits for incontinent supplies. Providers should not submit TARs for total amounts used, just the overage.
• When completing an incontinence supply TAR, providers should request the number of supply units exceeding the limit multiplied by the number of months requested. Providers should enter this number in the Quantity field on the TAR form and leave the Units of Service field blank. Providers must show a calculation on the TAR form for each requested supply exceeding $165 per recipient per month.
• For patients older than 5 years of age but younger than 21 years of age: When billing (HCPCS) codes, providers should follow direct billing limitations.
• TARs may be approved for amounts greater than the utilization limits with medical justification or documentation to support the request (for example, if the patient is bed-bound and taking medication resulting in increased urine output, chronic diarrhea or G-tube feeds).
• TARs for patients in Intermediate Care Facility for the Developmentally Disabled-Habilitative/Nursing (ICF-DDH/N) homes or who receive EPSDT services are usually authorized for one year or up to the expiration date on the prescription.
• For patients in ICF-DDH/N homes, mattress covers and gloves are not to be included on TARs using the Incontinent Supplies service category. These should be submitted using the Medical Supplies service category.
• Protective underwear (pull-on products) are approved for independence in toileting or for toilet training/habit training programs. Claims billed for protective underwear products are restricted to items on the Incontinence Contracted Product List for patients weighing more than 80 lbs. Providers should include a treatment plan and progress report or narrative on prescriptions including percentage of success, number of times successful and number of times toileted. Utilization limit is 120 per month.
   

General TAR Information

• Effective since November 1, 2008, providers must use a Medi-Cal-registered National Provider Identifier (NPI) on all TARs. If providers use legacy numbers the TARs may be denied.
• Providers should verify all information is accurate prior to submitting the TAR, including the patient's name, Medi-Cal ID and the provider NPI.
• Providers should not submit both an eTAR and paper TAR for the same service. Providers should choose only one method to submit a request to avoid duplication. 
• Providers should refer to the appropriate provider manual on the Medi-Cal website for further references.
   

The newly revised eTAR Program Information page gives quick access to:

• eLearning tutorials
• Tips and pointers for eTAR submission
• Downloading forms
• Upcoming training seminars
• Upcoming eTAR webinars

Reminder: Providers should utilize the eTAR application on the Medi-Cal website or call the Telephone Service Center (TSC) 1-800-541-5555 to inquire about a TAR. For self-paced online eTAR training, visit the eLearning page.