Medical Need/Prior Authorization

MDX240302.pdf

In re U S, OAH No. 24-0302-MDX, By: Toussaint, Lisa M. on 8/7/2024
MDX253167.pdf

In re N "G" C, OAH No. 25-3167-MDX, By: Schmidt, Robert M. on 3/2/2026

Burden of Proof

Currently Eligible for Medicaid or Denali Kid Care Recipient

Dental Services (Dentures, Orthodontia)

Direct Reimbursement

Durable Medical Equipment

Inpatient Authorization

Mootness of Issues

Necessary for Treatment of Illness or Injury, or Correction of Organic System

Non-Covered Procedures

Prescription Medicine

Prior Approval/Authorization

Provider Not Covered

Specialized Medical Equipment (SME)

State Medicaid Manual

Surgery

Timely Action by Department/Claims Administrator

Treating Physician’s Recommendation

Vision/Eye Glasses/Contacts