In an emergency, prior approval can be waived. An emergency situation must be life threatening, have the potential for causing permanent damage, or require services for immediate relief of significant pain. When an emergency exists,
immediate approval can be obtained by phone. When there is no time for approval, even by phone, or during non-business hours, the service may be provided without prior approval. See PM
20-03-03 for post approval procedures. However, services provided during an emergency may not continue as part of a long-term treatment without obtaining approval.
Once phone requests for prior approval have been approved the provider has to submit the request form to be paid. When there was not a phone request, the provider must submit the form for an approval decision.