Medical review
Attention exempt hospital outpatient departments (OPDs): Revised additional documentation request (ADR) letters
Due to a claim issue identified, exempt hospital OPDs will be receiving a revised exemption ADR letter with a revised letter fax cover sheet.
Payment issue affecting end stage renal dialysis services on type of bill 72X
Payment issue affecting end stage renal dialysis services on type of bill 72X.
Ambulatory surgical center (ASC) prior authorization request (PAR) submission guidelines
View these submission guidelines for ASC prior authorization requests.
Prior authorization program for repetitive scheduled non-emergent ambulance transports
Background
Submissions
Extended affirmation periods
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Repetitive scheduled non-emergency ambulance transport prior authorization claims submission guidelines
Follow this instructions to learn how to file a claim once you received the unique tracking number (UTN) related to the prior authorization of repetitive, scheduled non-emergency ambulance transports…
Prior authorization (PA) demonstration for certain ambulatory surgical center (ASC) services
CMS is delaying the start date for the PA demonstration for certain services provided in ASCs and will be implementing the demonstration in two phases. For more information on the delayed…
Ambulatory surgical center (ASC) prior authorization (PA) claim submission guidelines
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.
Prior authorization request (PAR) ambulatory surgical center (ASC) procedures Medicare Part B fax/mail coversheet
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 (…