KanCare Training for Providers - Ubhonline.com

Prior Authorization Requirements
• Referrals Not Required
– Members shall be able to
access all behavioral
health outpatient services
(mental health and
substance use) without a
referral up to a prespecified
initial
authorization service limit.
• Prior Authorization Required
– For services above established limits,
prior authorization is required and may
be obtained by members or providers.
– Prior authorization is required for
services that are more intensive than
outpatient, such as Day Treatment,
Partial, Inpatient.
– Providers must ensure that the prior
authorizations are in place before
rendering non-emergent services.
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