Do I need an authorization?
When TFL is the primary payer for certain services, you will need preauthorization. When Medicare or other insurance is the primary payer, you will not.
TFL does not make referrals to specialists or other providers.
The provider will handle preauthorization in most cases.
You will need preauthorization for these services when TFL is the primary payer:
- Skilled Nursing Facilities (SNF)
- Transplants
- Hospice when beneficiary only has Medicare Part B
- Extended Health Care Option
- Inpatient Mental Health and Substance Use Disorder
- Laboratory Developed Tests
- Femoroacetabular Impingement (FAI)
- Cancer Clinical Trials (CCT), reviewed for approvals by the authorization staff
- IVIG (Intravenous Immunoglobulin) Drugs
- AAT (Alpha-1 Antitrypsin) Drugs
- Low-Protein Modified Foods (LPMF) for Inborn Errors of Metabolism (IEM)
- Adjunctive Dental
- Home Health PPS
- Dental Anesthesia and Institutional Benefits
- Electroconvulsive Therapy (ECT)
- Transcranial Magnetic Stimulation (TMS)
- Psychoanalysis
- Applied Behavioral Analysis (ABA) services, contact regional contractor for authorization.
TFL will not approve services after the fact. If five days have passed since the service, the provider must submit a claim. They must include all supporting documents and send the claim through the website or by fax (608-301-2114). TFL may reduce payment 10% when services are not approved in advance, however ABA services will not be considered without an authorization.