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COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE MEDICAL ASSISTANCE PROGRAMS OUTPATIENT SERVICES AUTHORIZATION REQUEST MA 97 Detailed instructions for completing the MA 97 for either prior.

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How to fill out the MA 97 Form Pennsylvania online

The MA 97 Form is essential for requesting outpatient services authorization within Pennsylvania's Medical Assistance Programs. This guide provides a step-by-step process to help users fill out and submit this form online efficiently.

Follow the steps to complete the MA 97 Form online effectively.

  1. Press the ‘Get Form’ button to access the MA 97 Form, then open it in your preferred editing tool.
  2. Identify the type of request you are making in Items 1 & 2. Check one box only for either prior authorization or 1150 waiver. Ensure to fill out a separate form if both requests are needed.
  3. Complete Patient Information (Items 3–6) by entering the recipient number, patient's full name (last, first, middle initial), birthdate in MMDDCCYY format, and optionally, check the gender box.
  4. Input Provider/Prescriber Information (Items 7–11) with the provider's complete name, 13-digit Provider ID, Optional reference number, and complete details for payment recipients if applicable.
  5. If applicable, fill out the Referring Practitioner/Prescriber section (Items 12–15), including their name, license number, telephone, and address.
  6. Enter the Primary Diagnosis (Item 16) and corresponding ICD-9-CM Diagnosis Code (Item 17). Complete the Secondary Diagnosis section (Items 18-19) if necessary.
  7. For Requested Services (Items 20A-29), describe the services needed and enter the procedure codes, quantities, and financial specifics as indicated.
  8. Provide additional information under Item 27 about alternatives previously tried, and check the recipient's current residential status in Item 28.
  9. In Item 29, include a narrative description of symptoms or medical justification for your request before submitting any additional attachments in Item 30.
  10. Sign the form (Items 33-36) both by the patient or authorized representative and by the practitioner, ensuring dates and professional details are filled out.
  11. Once completed, save your changes, and proceed to download, print, or share the MA 97 Form online.

Start completing your MA 97 Form online today for swift authorization of outpatient services.

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In approximately half of the states, ABD Medicaid's income limit is $914 / month for a single applicant and $1,371 for a couple. In the remaining states, the income limit is generally $1,215 / month for a single applicant and $1,643 / month for a couple.

Prior authorization is not required for emergency or urgent care. Out-of-network physicians, facilities and other health care providers must request prior authorization for all procedures and services, excluding emergent or urgent care, as identified below.

Medical Assistance (MA), also known as Medicaid, pays for health care services for eligible individuals.

For example, a single person living alone cannot make more than $27,180 and a family of four cannot make more than $55,500. Note: A household is automatically eligible to receive weatherization assistance if an individual within the dwelling unit receives Supplemental Security Income.

Identity — Identity can be verified by a driver's license, state identification card or another piece of identification. Social Security Number (SSN) — A SSN must be provided for each person applying for Medical Assistance. County Assistance Office staff will help you apply for an SSN for anyone who does not have one.

The 2023 maximum is $148,620, and the 2023 minimum is $29,724.

In PA, the spend down amount is calculated for a 6-month period. Once one has met their spend down, they will be income-eligible for Medicaid services for the remainder of the period. The MNO-MA asset limits are $2,400 for an individual and $3,200 for a couple. There is no additional asset disregard.

Eligibility levels for parents are presented as a percentage of the 2023 FPL for a family of three, which is $24,860. Eligibility limits for single adults without dependent children are presented as a percentage of the 2023 FPL for an individual, which is $14,580.

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