Prior authorization
Prior Authorization Program Initiatives
Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process allows the provider to submit documentation prior to providing or billing…
Prior Authorization Program Initiatives
Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process allows the provider to submit documentation prior to providing or billing…
Prior Authorization Program for Certain Hospital Outpatient Department Services - Claim Submission Guidelines
Claims submitted for a prior authorization request (PAR) that received a provisional affirmation PA decision, including any service that was part of a partially affirmed decision, must include the 14…
Prior Authorization Program for Certain Hospital Outpatient Department Services - Claim Submission Guidelines
Claims submitted for a prior authorization request (PAR) that received a provisional affirmation PA decision, including any service that was part of a partially affirmed decision, must include the 14…
Prior Authorization Program for Certain Hospital Outpatient Department Services
CMS implemented a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020.
Ambulatory Surgical Center Prior Authorization Request Submission Guidelines
View these submission guidelines for ASC prior authorization requests.
Prior Authorization Program for Certain Hospital Outpatient Department Services
CMS implemented a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020.
Prior Authorization Demonstration for Certain Ambulatory Surgical Center Services
CMS is implementing a five-year demonstration project for the prior authorization of certain services provided in Ambulatory Surgical Centers (ASCs) and will be implementing the demonstration in two…
Ambulatory Surgical Center Prior Authorization Claim Submission Guidelines
Prior authorization (PA) for the ASC prior authorization demonstration is voluntary. However, if a provider elects to bypass PA, applicable ASC claims will be subject to prepayment medical review.
Repetitive Scheduled Non-Emergent Ambulance Transportation Glossary Tool
The following article provides a list of common terms used by the medical review department for prior authorization requests.