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.
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 to include a new web address for the required prior authorization list. All other information remains the same. [MM9940]
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]
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]
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