Specifications include, but are not limited to: •Meet the federal and state certification requirements for the Department of Social Services. •Meet the timeframes for completion of a clean PA designated by the state. •Provide interfaces for other agencies/sub-agencies as needed. •Automate PA determinations with flexibility to add new or modify existing rules. • Create and add service codes to PA automated system, including: omental health with service limits oinpatient psychiatric units ospecial diagnosis/procedure codes •Identify service categories that are subject to the same limitation and accumulate the same combination of services. Use combined services to compare to service authorization limit. •Update PA records based on claims processing to indicate that the authorized service has been used or partially used, including units and/or dollars, during each PA request period. •Provide flexibility to allow PAs to be capped at a dollar amount at the recipient level, at the service level, at the provider level or any combination that can be controlled and/or measured through available claim/PA file data as determined by business rules approved by the State.
