Reminder: Medicare Prior Authorization Information Not Valid for Part B Submission – Claims Will Reject as Unprocessable

This notice is being published as a reminder to all Medicare Part B providers. When you are submitting a claim to National Government Services for Part B consideration, you are to submit valid claim related information. Providers should not be submitting this information on Part B claims because, at this time, Part B is not involved in a prior authorization program that would require the information. 

Based on this, if you are submitting claims electronically, this would apply to information that is submitted in the 2300 and 2400 Loop REF segment, in the REF01 and REF02 data elements. If a Part B claim is submitted with the G1 qualifier in REF01 and submitted value in REF02, the claim will reject and will not be processed. If you are submitting information in these loops/segments, at this time, you will need to make sure your electronic claims vendor/clearinghouse will discontinue that submission because it will continue to lead to claim rejections.

NGS has seen an influx of claims submitted to Medicare Part B for consideration which includes this prior authorization information on services that have been submitted to Medicare Part B inappropriately. Those claims will be rejected. They will require a resubmission without that data being added to the claim before the services can be processed and adjudicated properly. 

Posted 7/9/2021