Prior Authorization Exemption Status Inquiry Tool

This is a self-service tool to allow both hospital or physician office staff responsible for submitting prior authorization requests (PARs), to check the exempt status of the HOPD. This tool will only recognize the hospital 6-10 digit PTAN (CCN) number. If the PTAN entered is not recognized, it is an indication that a PAR is required.

Please note: Physician, Ambulatory Surgical Center and Critical Access Hospital PTAN entries will not return results; however a PAR is not required for these facility types. Only hospital outpatient departments billing with a Type of Bill (TOB) code 13x require prior authorization.

Updates to this tool are completed annually. Please check back on or after December 10 each year for the most up-to-date OPD exemption status.

Reviewed 6/12/2024