Prior authorization
Prior authorization program initiatives
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…
Rhinoplasty and related services
Nasal surgery is any procedure performed on the external or internal structures of the nose, septum or turbinate.
Panniculectomy, excision of excess skin and subcutaneous tissue (including lipectomy), and related services
Effective for dates of service July 1, 2020, and after, hospital outpatient department (HOPD) providers will need to obtain prior authorization (PA) for panniculectomy, excision of excess skin and…
Prior authorization program for repetitive scheduled non-emergent ambulance transports
Background
Submissions
Extended affirmation periods
Prior authorization program for repetitive, scheduled non-emergent ambulance transports (RSNAT)
CMS has implemented the prior authorization program for certain repetitive, scheduled non-emergent ambulance transports in Florida, Puerto Rico and the US Virgin Islands. Learn more about the program…
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.
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.
Hospital outpatient department (OPD) prior authorization (PA) exemption process reminders
Hospital outpatient departments that qualify for an exempt status effective January 1, need to have at least 10 claims submitted and finalized.
Hospital outpatient department (OPD) prior authorization (PA) exemption process reminders
Hospital outpatient departments that qualify for an exempt status effective January 1, need to have at least 10 claims submitted and finalized.
Prior authorization (PA) program for certain hospital outpatient department (OPD) services - submitting the prior authorization request (PAR)
View these submission guidelines when submitting prior authorization requests for certain hospital outpatient department services.