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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.
This edition includes information on preventing claim denials for ostomy supplies, revised ZIP code files for CBSAs, chronic care management services, and more.
View helpful hints for completing the CMS-855B application.
View instructions on completing the CMS-20134 enrollment application.
Access tools and forms related to the prior authorization program, CERT, and provider audit.
This edition includes information on fiscal year 2026 final payment rules.
This edition includes information on crushing fraud, preventing E/M claim denials, a CMS listening session, and more.
Due to a claim issue identified, exempt hospital OPDs will be receiving a revised exemption ADR letter with a revised letter fax cover sheet.
CMS released a new version of Form CMS-460 (version 12/28). The former version (11/22) will no longer be accepted by the MACs after March 6, 2026. Read these instructions to complete the CMS-460 form.
MLN Connects for Thursday, August 14, 2025