Prior Authorization of Pediatric Hospitalizations

Prior Authorization (PA) of hospital admissions and certain outpatient procedures is required by the Department of Community Health (DCH).  This requirement includes authorization for hospital admissions and for procedures that are performed in an outpatient hospital or ambulatory surgical center.  As of October 1, 2006, DCH will eliminate the age exemption for this type of prior authorization.  Consequently, prior authorization of these services will also apply to Members under twenty – one (21) years of age.

To accommodate training needs, a Pediatric Hospitalization PA training session has been recorded and is available for viewing.  To access the recorded session, you will be prompted to complete a registration page. (The registration information will be used to provide updates regarding future training sessions offered by GMCF.)  Upon completion of the registration information, access will be granted to the WebEx file and viewer.  Instructions on how to download the WebEx file and viewer will be provided at that time.  Click the link below to register.

Registering for a recorded Pediatric Hospitalization PA training session

As additional training aids, a PowerPoint Presentation of the PA process and a web entry guide with step by step instructions are available.  Use the links below to access these training resources.

Hospital Admissions and Outpatient Procedures web entry guide (PDF)
Hospital Admissions and Outpatient Procedures presentation (PowerPoint)

Please direct all questions regarding Prior Authorization of Pediatric Hospitalizations training to PEDSAdmissions@gmcf.org