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Access tools and forms related to the prior authorization program, CERT, and provider audit.
Due to a claim issue identified, exempt hospital OPDs will be receiving a revised exemption ADR letter with a revised letter fax cover sheet.
Use these checklists to ensure you have met medical documentation requirements based on specific services.
This document was developed based on questions and answers posed during our webinars on the PA demonstration for ASC services.
Top denial/ partial denial reasons and high-level results are listed below from each round of Transitional Care Management (TCM) services TPE reviews that have been conducted thus far by Medical Review.
View these submission guidelines for ASC prior authorization requests.
The PAR fax/mail coversheet for ASCs is now available for Florida ASCs participating in the ASC PA demonstration. ASCs in Florida can submit PARs beginning on January 5, 2026, for dates of service (DOS) on or after January 19, 2026.
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.
When a medical reviewer contacts the provider requesting to submit an attestation statement or signature log to authenticate a medical record, the provider must submit the attestation statement or signature log within 20-calendar days.