Tools & forms: Compliance / Review
Tools
CERT CID Lookup
HOPD/ASC CalculatorForms
Prior authorization
| Form | Description |
|---|---|
| Use this coversheet to submit a prior authorization request (PAR) for repetitive scheduled non-emergent ambulance transports (RSNAT) before the service is provided to the beneficiary and prior to the claim being submitted for processing. | |
| Use this coversheet to submit a prior authorization request (PAR) for certain hospital outpatient department services before the service is provided to the beneficiary and prior to the claim being submitted for processing. | |
| Use this coversheet to submit an expedited prior authorization request (PAR) for certain hospital outpatient department services. This form should only be submitted if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function. |
Provider audit
| Form | Description |
|---|---|
| This form is used by Medicare Part A providers who change the default or other contact who receives their interim rate, tentative settlement, NPR & NOC-PR determinations. |