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The Managed Care Support (MCS) Manuals (T-3) for contracts prior to 07/21/2016 are now superseded and can be found in the "Superseded" portion (indicated by a red banner) of each T-17 manuals' web page.
Providers
Chapter 11
Section 4.1
Unauthorized
Institution: Related Professional Services
Issue Date: January 26, 1987
Revision:
1.0 POLICY
Otherwise covered services
rendered by an authorized professional provider who is not employed
by or contracted with the institution may be cost-shared even though
the medical services were furnished in an unauthorized institution
for which benefits cannot be extended.
2.0 EXCLUSION
Inpatient mental health services,
partial hospitalization, or any other care that falls under the waiver
of liability provision. For example, when preauthorization is required
as for inpatient mental health services and partial hospitalization
and has not been obtained, payment may not be made for any of the
services, either institutional or those rendered by an authorized
professional provider who is not employed or contracted with the
institution.
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