CMS is implementing a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020. Review the fax coversheet needed for submission.
The Centers for Medicare & Medicaid Services is implementing a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020.
The following document was developed based on questions and answers posed during our webinars on the prior authorization (PA) program for certain hospital outpatient department (OPD) services.
Expedited Prior Authorization Request Hospital Outpatient Procedures Medicare Part A Fax/Mail Coversheet - Allowable if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function.
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.
First Coast will begin accepting prior authorization requests (PARs) for the following hospital outpatient department (OPD) services on June 17, 2020, for services provided beginning on or after July 1, 2020. To meet coverage criteria, the patient's medical record must contain documentation that fully supports the medical necessity for services.
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]
Change request (CR) 9940 updated 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, 2017, to include a new web address for the required prior authorization list. All other information remains the same. [MM9940]
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]
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.
