Last Modified: 7/6/2020
Location: FL, PR, USVI
Business: Part A, Part B
A provisional affirmation PA decision is a preliminary finding that a future claim submitted to Medicare for the service(s) likely meets Medicare's coverage, coding and payment requirements. The provisional affirmation PA decision and corresponding unique tracking number (UTN) is valid for 120 days. The 120 days begins with the date on the decision letter. For example: if the PA request (PAR) is affirmed on January 1, 2021, the PAR will be valid for dates of service through April 30, 2021. Otherwise, the provider will need to submit a new PAR.
The service listed on the PAR must be performed within 120 days. If the date of service (DOS) for the service listed is performed outside the 120 days, the UTN is no longer valid and a new PAR will be required. It is important to note that the 120 days on the UTN does not impact claims timely filing. As for the claim itself, it must be filed within one year of the actual DOS.
Our HOPD PA calculator will help you determine the time you have remaining to perform the approved procedure before the authorization expires. Enter the date of the PA affirmation from the decision letter, and then click calculate. The tool will tell you the last date your authorization will be valid.