Common use of Necessary Services Requiring Authorization in Any Setting Clause in Contracts

Necessary Services Requiring Authorization in Any Setting. The following services, irrespective of health care delivery setting require authorization from TMA. These services are reimbursed separately from DVA inpatient interagency rates, if one exists or actual DVA cost: transportation, prosthetics, non-medical rehabilitative items, durable medical equipment. orthotics (including cognitive devices), routine and adjunctive dental services, optometry, lens prescriptions. inpatient/outpatient TBI evaluations, special diagnostic procedures (see Appendix A-6), inpatient/outpatient Transitional Rehabilitation program, home care, personal care attendants, conjoint family therapy. cognitive rehabilitation, and extended care/nursing home care. Professional charges will be billed on CMS 1500 and Facility Charges will be billed on UB04, as applicable. The DVA facility will be reimbursed separately for ambulatory surgeries required while in a rehabilitation or transitional rehabilitation program setting. TMA will provide standardized claim processing instructions (i.e., application of revenue codes) to the MCSCs to enable DVA facilities to bill and receive reimbursement in a consistent manner, per this MOA.