Hospital outpatient department (OPD) prior authorization (PA) exemption process reminders

Exempt hospital OPDs are reminded that they will receive an additional documentation request (ADR) on August 1 for a 10 claim post-pay sample on finalized claims with DOS on or after January 1 through June 30. Providers will have 45 days to submit documentation. Providers are required to meet a 90% compliance rate to remain exempt.

Providers who did not have a minimum of 10 finalized claims with DOS on or after January 1 through June 30 will not participate in the ADR process and will be withdrawn from exemption. 

Visit our prior authorization exception process article for additional information.