General PAR Documentation
Requesters must include the following data elements in all PARs to avoid potential delays in processing. Your MAC may request additional, optional elements for submission of the PAR.
Initial Submission Documentation:
Beneficiary Information (as written on their Medicare card)
- Beneficiary Name
- Beneficiary Medicare Number (also known as the MBI)
- Beneficiary Date of Birth
Hospital OPD Information
- Name of facility
- PTAN/CCN
- Facility Address
- Facility NPI
Physician/Practitioner Information
- Physician/Practitioner’s Name
- Physician/Practitioner’s NPI
- Physician/Practitioner PTAN
- Physician/Practitioner’s Address
Requestor Information
- Requestor Name
- Requestor Phone Number
- Requestor Email Address
Other Information
- Anticipated Date of service
- HCPCS Code(s)
- Diagnosis Code(s) (providers who submit using esMD must include a diagnosis code(s))
- Type of Bill
- Units of Service (providers who submit using esMD must include units of service)
- Indicate if the request is an initial or subsequent review
- Indicate if the request is expedited and the reason why
Resubmission(s) documentation:
In addition to the required PAR documentation in the Initial Submission section, the resubmission of the PAR should contain an exact match of the beneficiary's first name, last name, date of birth to the previous submission, and the UTN associated with the previous submission.
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National Government Services
Mailing Address:
National Government Services
P.O. Box 7108
Indianapolis, IN 46207-7108
Fax#: 317.841.4530
esMD: indicate document/ content type 8.5
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National Government Services
Mailing Address:
National Government Services
P.O. Box 7108
Indianapolis, IN 46207-7108
Fax#: 317.841.4528
esMD: indicate document/ content type 8.5
*Submissions through esMD will be available beginning 7/6/2020. For more information about visit esMD, or contact your A/B MAC.
The requester can submit an expedited review of the PAR if it is determined that a delay could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function. However, if medical documentation does not support an expedited process, the request will be subject to the normal timeframe. We will make reasonable efforts to communicate a decision within two business days of receipt an accepted expedited request.