Codes that require authorization Prior authorization is a process started by the ordering physician. Once a prior authorization is requested, El Paso Health will determine whether that treatment is medically necessary using medical criteria. It is a Provider’s responsibility to know which specific codes need prior authorization, and El Paso Health can help. You can use our Prior Authorization Tool and online catalog to check if prior authorization is required for your services. ■The Prior Authorization Catalog is a PDF list of CPT codes that you can search to see if prior authorization is needed. ■The Prior Authorization Tool is a search engine with which you can search for up to 4 CPT codes at a time to check if prior authorization is needed. For more information about our turnaround times, medical criteria, and forms, please visit our website at elpasohealth.com/providers/ medicaid-chip-prior-authorization or call us at 915-532-3778 or toll-free at 1-877-532-3778. Please note that prior authorization is subject to covered benefit review and is not a guarantee of payment. resources Tell your patient’s story with accurate and complete documentation For many reasons, documentation is required for any service given to a patient. First and foremost, missing or inaccurate documentation can cause a patient’s quality of care to suffer. Clinicians might make medical errors if they don’t have a complete picture of the patient’s health. This can lead to poorly planned care or incorrect treatments. Patients often have multiple clinicians. A patient’s care is especially affected when different members of their health-care team don’t communicate well. Without proper documentation, patients may receive conflicting treatment plans, disrupting their continuous care. In addition to patients and Providers, coders also rely on complete and accurate documentation. They need documentation in order to assign the correct CPT and ICD-10 codes and required modifiers for procedures. Coders also follow regulatory guidelines to ensure proper reimbursement. Compliance in medical coding is not just about following rules; it’s about protecting the integrity of patient data, optimizing billing processes, and ensuring providers are reimbursed accurately for their services. Clear and concise medical record documentation is critical for providing patients with quality care, ensuring accurate and timely payment for services, reducing malpractice risks, and helping health-care Providers plan and evaluate the patient’s treatment and maintain continuous care. 2
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