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Standard PAR coversheet for ASC
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Use this coversheet to submit a prior authorization request (PAR) for certain ambulatory surgical center (ASC) services before the service is provided to the beneficiary and prior to the claim being submitted for processing. |
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Expedited PAR coversheet for ASC
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Use this coversheet to submit an expedited PAR for certain ASC procedures. This form should only be submitted if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function. |
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Standard PAR coversheet for hospital OPD
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Use this coversheet to submit a PAR for certain hospital outpatient department services before the service is provided to the beneficiary and prior to the claim being submitted for processing. |
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Expedited PAR coversheet for hospital OPD
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Use this coversheet to submit an expedited PAR for certain hospital outpatient department services. This form should only be submitted if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function. |
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Standard PAR coversheet for RSNAT
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Use this coversheet to submit a PAR for repetitive scheduled non-emergent ambulance transports (RSNAT) before the service is provided to the beneficiary and prior to the claim being submitted for processing. |
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