 Effective September 1, 2014, Smoky Mountain LME/MCO will no longer require prior authorization for up to nine units combined of the following Medicaid testing procedures: Psychological Testing (96101), Developmental Testing (96111), Neurodevelopmental Testing (96116), Neuropsychological Testing (96118) and Developmental Testing Limited (96110). Prior authorization will still be required for more than nine units combined of these testing services for a Medicaid recipient in a 12 month period. Prior authorization will also still be required for all testing under the State-Funded benefit. While prior authorization will not be required for testing under the Medicaid benefit as described above, providers are still required to adhere to the medical necessity guidelines for testing as presented in Clinical Coverage Policy 8C (http://www.ncdhhs.gov/dma/mp/8C.pdf) and in the Smoky Guidelines for Psychological Testing (http://www.smokymountaincenter.com/documents/providers/authinfo/SMC_Psych_Testing-Guidelines.pdf). In particular, please note the following guidelines: · Except to determine eligibility for I/DD services, diagnostic interviewing (e.g., a current Comprehensive Clinical Assessment) should be conducted first and Psychological Testing performed only when questions remain that cannot be addressed through clinical interview. · Smoky values Psychological Testing to clarify diagnoses and to make treatment recommendations when those issues cannot be clarified through diagnostic interview. · Psychological Testing is not covered in situations such as the following: o Testing for primarily educational purposes, including for cognitive abilities, learning disabilities and academic achievement. o Vocational referrals, including the need for Vocational Rehabilitation services, job placement, vocational interests and aptitudes, or fitness for duty. o Referrals for preparation for civil or criminal court proceedings. o Routine testing for the diagnosis of ADHD. · No more than five units of testing per day per consumer may be billed as outlined in Clinical Coverage Policy 8C. Smoky will conduct post service reviews of Psychological Testing for which claims are paid; providers could be at risk for corrective actions or recoupment if the above guidelines are not followed. We believe that these changes will reduce the administrative burden for providers and will facilitate quicker access to services for consumers. Should you have any questions or wish to discuss this communication further, please contact a Care Manager at (866) 990-9712, option 5. | 
