<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.09.06" title_num="10" subtitle_num="09" chapter_num="09" heading="Preauthorization Requirements.">
  <paragraph num="A.">
    <text>Preauthorization is required for any service identified as needing preauthorization in the current laboratory fee schedule, in accordance with Regulation .07D of this chapter.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The provider shall submit the request for preauthorization according to the procedures established by, and in the form designated by, the Department.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Preauthorization is issued when:</text>
    <paragraph num="(1)">
      <text>Program procedures are met; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The provider submits to the Department adequate documentation demonstrating that the service to be preauthorized is medically necessary.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Preauthorization is valid for services rendered or initiated within 90 days of the date issued.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Preauthorization for Services Billed to Medicare.</text>
    <paragraph num="(1)">
      <text>If Medicare covers and approves a service for which preauthorization by the Program is normally required, the Program shall waive preauthorization requirements for that service.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If Medicare rejects the entire claim or any part of a claim for a service that normally requires preauthorization, and the claim is referred to the Program for payment, the Program shall pay only for the Medicare-rejected covered services if authorization for those services was obtained prior to the date of service.</text>
    </paragraph>
  </paragraph>
</regulation>