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Prior authorization

Modified: 5/2/2017
Change request (CR) 9940 updates the Centers for Medicare & Medicaid Services (CMS) ‘Program Integrity Manual’ to permit the Medicare administrative contractor to conduct prior authorization processes, as directed by CMS through individualized operational instructions. This article was revised May 1 to include a new web address for the required prior authorization list. All other information remains the same. [MM9940]
Modified: 4/25/2017
Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process allows the provider to submit documentation prior to providing or billing the service. The contractor will then alert the submitter of any potential issues with the submitted information.
Modified: 2/20/2017
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) expands the repetitive scheduled non-emergent ambulance transport prior authorization model to all states if the program meets certain requirements. [CR9940]
Modified: 2/20/2017
The Centers for Medicare & Medicaid Services (CMS) is releasing results from the first year of the Non-Emergent Hyperbaric Oxygen (HBO) Therapy Prior Authorization model. [CR9940]
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.