Prior authorization for hospital outpatient department services: Don’t wait too long to submit your prior authorization requests

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Home ► Prior authorization ► Prior authorization for hospital outpatient department services: Don’t wait too long to submit your prior authorization requests

Last Modified: 11/19/2024 Location: FL, PR, USVI Business: Part A, Part B

Prior authorization for hospital outpatient department services: Don’t wait too long to submit your prior authorization requests

Medicare has prescribed guidelines and timeframes associated with prior authorization requests (PARs). For a standard request, First Coast will complete the review and send a decision letter within 10 business days of receipt of the request. For expedited requests, we’ll make efforts to communicate a decision within two business days of receipt of the expedited request.

Note: An expedited request applies to cases where delays in response could jeopardize the life or health of the patient. If life-threatening documentation is not provided to support an expedited scenario, the request will be processed within 10 business days.

Best practice: Submit early

Best practice is to not schedule surgery until an approved prior authorization is received and to submit a PAR at least two weeks prior to the date the procedure is recommended to be performed. Remember, a provisional affirmation of a PAR is valid for 120 days from the decision date.

If your PAR is non-affirmed or partially non-affirmed, a subsequent PAR may be submitted with additional documentation. A PAR resubmission decision letter will be communicated within 10 business days of the receipt of the request.

Note: Effective for PARs received January 1, 2025, and after the decision letter will be issued within 7 calendar days

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