Prosthetics and Orthotics Vendor Questions

1. How do I create an authorization for a client who requires bilateral devices?

There is a simple way of remembering how to record bilateral clients and that is 2-1-2

2 lines on the "history" screen (1 for LL and 1 for LR)

1 line on the authorization (Qty = 2 BL)

2 lines on the claim (1 for LL and 1 for LR)

An example for bilateral clients is as follows:

A. Step 3 Update History Screen Requires two lines:

• one line for LLAFO and
• one line for LRAFO

B. Under the Benefit Information Screen enter:

• One Cat # - qty 2 – indicate - BLAFO in serial number field.

C. The claim requires two lines:

• LRAFO in serial number field
• LLAFO in serial number field

2. The client is bilateral, but I'm only authorizing a catalogue number for one side. How do I do this?

As long as the client history has the two lines pertaining to the bilateral device, you can enter in your catalogue number on Step 5 as a quantity of "1" and then put in the serial number for the affected side (i.e. LLAFO).

3. What documentation is required for a repair?

For repair authorizations, you must provide a description of the repair, the cost of materials, the total cost of the repair (hours and materials) and the percentage of the total repair cost of the device on the client benefit note. For repairs over $800.00, you require prior approval from the AADL Prosthetics and Orthotics Program Manager.

4. How do I make sure I put the correct devices in the serial number field of the claim?

Refer to the Orthotic Grouping Table for the catalogue numbers for each device.

5. What happens if I get an error message "CAT # NOT VALID FOR ORTHOTIC DEVICE" when creating an authorization?

You should look up the Catalogue number in the Orthotic Grouping Table to ensure it is under the correct device.