Prior Authorization Outpatient Department Exemption Additional Documentation Requests

National Government Services Prior Authorization initiated the process of issuing ADRs to exempt providers. Please monitor your facility’s ADR location within the Medicare billing system for these claim requests.

If your facility typically submits ADRs through the NGSConnex portal, you will be able to locate and respond to ADRs within the list.

Prior Authorization Reminders

• Each exempt provider will receive requests for ten postpayment claims that include prior authorization services, billed since 1/1/2023.
• Providers have 45 days to respond to ADR requests.
• NGS has 45 days to render a decision on each claim.
• Non-responses to ADR requests will automatically deny on day 46.
• Results will be issued by 11/2/2023.
• The Exemption status inquiry tool (link below) will be updated by 12/10/2023.

Related Content

• OPD Operational Guide
• The Exemption Process Frequently Asked Questions
• Prior Authorization Exemption Status Inquiry Tool
• NGSConnex User Guide

Posted 7/21/2023