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Prior authorization

Modified: 3/4/2021
The Centers for Medicare & Medicaid Services is implementing a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020.
Modified: 3/4/2021
CMS may elect to exempt a hospital OPD provider from the hospital OPD prior authorization process upon a provider's demonstration of compliance with Medicare coverage, coding, and payment rules. This exemption would remain in effect for a six-month period or until CMS elects to withdraw the exemption.
Modified: 2/18/2021
First Coast will begin accepting prior authorization requests (PARs) for the following hospital outpatient department (OPD) services on June 17, 2020, for services provided beginning on or after July 1, 2020. To meet coverage criteria, the patient's medical record must contain documentation that fully supports the medical necessity for services.
Modified: 1/22/2021
The following document was developed based on questions and answers posed during our webinars on the prior authorization (PA) program for certain hospital outpatient department (OPD) services.
Modified: 1/2/2021
The following are tips and reminders that will assist providers in avoiding a delay or dismissal of a Prior Authorization Request.
Modified: 1/2/2021
Prior Authorization Request Hospital Outpatient Procedures Medicare Part A Fax/Mail Coversheet
Modified: 1/2/2021
Expedited Prior Authorization Request Hospital Outpatient Procedures Medicare Part A Fax/Mail Coversheet - Allowable if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function.
Modified: 12/5/2020
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 the service. The contractor will then alert the submitter of any potential issues with the submitted information.
Modified: 10/7/2020
The Centers for Medicare & Medicaid Services (CMS) is releasing results from the first year of the Non-Emergent Hyperbaric Oxygen (HBO) Therapy Prior Authorization model. [CR9940]
Modified: 9/30/2020
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-byte unique tracking number (UTN) number listed on the decision letter. The hospital OPD claim is reported on a type of bill 13X. If all Medicare coverage, coding, and payment requirements are met, the claim will likely be paid.
Modified: 9/23/2020
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
Modified: 8/31/2020
CMS is implementing a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020. Review the fax coversheet needed for submission.
Modified: 8/27/2020
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) expands the repetitive scheduled non-emergent ambulance transport prior authorization model to all states if the program meets certain requirements. [CR9940]
Modified: 7/15/2020
To submit a prior authorization request, complete the prior authorization coversheet. Failure to populate every field could result in delays in processing your request, a non-affirmed decision, or a determination that the request is incomplete and cannot be processed.
Modified: 7/6/2020
Use this calculator to determine the time remaining to perform the approved procedure before the authorization expires.
Modified: 5/18/2020
View these submission guidelines when submitting prior authorization requests for certain hospital outpatient department services
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.