WAG 20-03-03

In a qualifying emergency (see PM 20-03-02), a provider may request approval after the service or item was provided. All requirements for prior approval have to be met and the request has to be made within 90 days from when the service or item was provided, with the following exceptions:

  • If the client's application was pending when the service or item was provided, the request can be made up to 90 days after the date benefits were approved.
  • If the client did not tell the provider they were receiving medical, the provider has up to 6 months from when service was given. The provider has to submit documentation, such as a bill or collection notice, that shows the provider did not know they should bill HFS.
  • If the bill was submitted to a third party payor within 6 months and was rejected, the provider must bill HFS within 90 days of the rejection.

Notification requirements are the same for post approval and prior approval.