Reminders on the Prior Authorization Program for Certain Hospital Outpatient Department Services
Effective for dates of service on or after 7/1/2020, a PAR is required for certain OPD services.
Hospital Responsibility: Submission of PARs
CMS requires the hospital/hospital outpatient department to complete the PAR with input from applicable physicians for services requiring prior authorization to be performed in the hospital outpatient department. Prevent unnecessary denials by completing all fields on the PAR request form and include accurate facility contact information.
National Government Services is aware that many Part B providers do submit PARs on behalf of the hospital outpatient department and will accept such requests when all required information has been included within the request.
NGS Identified Two Issues
NGS has noticed that some providers are rendering services before the PAR has been approved which will result in the associated claim not being approved for reimbursement.
In addition, NGS has identified an issue with claims for services subject to prior authorization that contain a previously used UTN. The UTN is valid for one-time use and is required on the hospital outpatient claim (13X type of claim) for applicable service(s); however, the UTN is not required on the physician’s claim. Reuse of a UTN is not allowed and the associated claim cannot be reimbursed.
Did you know that the easiest and secure method for submitting PARs is via NGSConnex?
NGSConnex is the preferred method for hospital outpatient departments to submit PARs. NGSConnex allows you to submit the PAR and documentation as well as to check the status of all PARs submitted via NGSConnex. Thus, NGSConnex will ease the burden of submitting your PARs and save you time.
Want to learn how to use NGSConnex to complete a PAR? We have a YouTube video titled How to Initiate and Check Status of Prior Authorization Requests for OPD Services in NGSConnex that will make this easy.
Procedure Code(s) and the PAR
The PAR provisional affirmation applies only to the specific services/codes requested via the PAR. If there is any potential that the procedure might change during surgery, then the provider should submit a PAR with several potential service codes. Please note that the documentation should support the need for all of the services requested.
Related Content
- Prior Authorization Program for Certain Hospital Outpatient Department Services
- Prior Authorization for Certain Hospital Outpatient Department (OPD) Services
Includes:
Posted 2/17/2021