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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…
Scribe services
A scribe is a person who documents the physician's dictated notes, patient conversations, and activities during the visit, usually in real time. Scribes are not, in themselves, providers of items or…
Prior authorization for ambulance transports is for repetitive transports
A repetitive service is defined as medically necessary ambulance transportation that is furnished three or more times during a 10-day period OR at least once per week for at least three weeks.…
Intensive outpatient program (IOP) billing requirements for institutional services
Effective January 1, 2024, IOP services are available for both individuals with mental health conditions and individuals with substance use disorders. This article addresses institutional billing…
Guidelines for billing acute inpatient noncovered days
This article provides guidance for billing provider-liable acute inpatient non-covered and acute partial inpatient non-covered days, and acute inpatient non-covered beneficiary-liable days.
Customer service hours of availability for U.S. Virgin Islands and Puerto Rico providers
With daylight saving time beginning, the Provider Contact Center hours of operation will be modified for providers in the U.S. Virgin Islands and Puerto Rico.
Customer service hours of availability for U.S. Virgin Islands and Puerto Rico providers
With daylight saving time beginning, the Provider Contact Center hours of operation will be modified for providers in the U.S. Virgin Islands and Puerto Rico.
Guidelines for billing acute inpatient noncovered days
This article provides guidance for billing provider-liable acute inpatient non-covered and acute partial inpatient non-covered days, and acute inpatient non-covered beneficiary-liable days.
Prior authorization: Facet joints and cervical fusion
CMS has removed CPT codes 64492 and 64495 from the listing of codes requiring prior authorization. View our article to learn more about these changes.