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TITLE 1 - ADMINISTRATION
PART 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 353 - MEDICAID MANAGED CARE
SUBCHAPTER E - STANDARDS FOR MEDICAID MANAGED CARE
SECTION/RULE ยง353.425 - MCO Processing of Prior Authorization Requests Received with Incomplete or Insufficient Documentation
Chapter Review Date 04/25/2024

(a) The rules in this section apply when a prior authorization (PA) request is submitted with incomplete or insufficient information or documentation on behalf of a member who is not hospitalized at the time of the request.(b) In this section, "incomplete PA request" means a request for service that is missing information or documentation necessary to establish medical necessity as listed in the PA requirements on the managed care organization's (MCO's) website.(c) An MCO must comply with