Prior authorization 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 along with appropriate documentation.
- Providers are asked to make sure the PAR hospital outpatient procedures Medicare fax/mail coversheet 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 provided.
- Providers are asked to make sure the PAR hospital outpatient procedures Medicare fax/mail coversheet is being used and that all fields on the PAR coversheet are completed.
- 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)
- 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
- A copy of the initial PAR cover sheet and all documentation from the initial submission
Click here to view additional information related to the prior authorization program.