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Last Modified: 4/12/2024 Location: FL, PR, USVI Business: Part A, Part B

Prior authorization (PA) for certain hospital outpatient department (OPD) services tips and reminders

The PA team has been receiving and processing prior authorization requests (PAR) for certain hospital OPD services. View the following reminders prior to submitting your request:
Providers are reminded that the PAR must include a PAR coversheet pdf file along with appropriate documentation. 
Providers are asked to make sure the PAR hospital outpatient procedures Medicare fax/mail coversheet external pdf file is being used and that all fields on the PAR coversheet are completed.
Remember that PA is only required for procedures on the CMS list external pdf file provided.
The PA is only required for the hospital outpatient department (OPD) who will be billing on the type of bill (TOB) 13X
PA for hospital OPD does not apply to Ambulatory Surgical Centers (ASCs)
PAR resubmissions must include the following:
A copy of the initial PAR cover sheet and all documentation from the initial submission
Any additional information/documentation
Click here to view additional information related to the prior authorization program.
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.