Prior Auth Required

14526 - 1(d)(1), (3), (4) and (5); and (e) of the W&I Code (summarized in a. through e. below)

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Service1(d)(1), (3), (4) and (5); and (e) of the W&I Code (summarized in a. through e. below)
Procedure / Service Description

To qualify for CBAS services, members must be over the age of 18 and meet one of the following specific - • Has been determined by DHCS to meet the NF-A level of care or above, and • Meets eligibility and medical necessity criteria contained in Sections 14525(a), (c), (d) and (e); 14526.1(d)(1), (3), (4) and (5); and 14526(e) of the W&I Code (summarized in a. through e. below): o The individual is 18 years of age or older and has one or more chronic or post-acute medical, cognitive, or mental health conditions, and a physician, nurse practitioner or other health care

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.