Prior Authorization Request Reminders
Effective for dates of service on or after 7/1/2020, a PAR is required for certain OPD services. For additional information on the Medicare Prior Authorization Program go to our website > log in to any Part A site > select the Medical Policy & Review tab > select Medical Review > select the blue button “Prior Authorization Program for Certain Hospital Outpatient Department Services”.
In addition, The Centers for Medicare & Medicaid Services website contains information, including a list of Frequently Asked Questions, on the Prior Authorization for Certain Hospital Outpatient Department (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.
PAR Provisional Affirmation/Approval
Provisional affirmation is the term used to indicate that the PAR is approved. Provisional affirmation means that a future claim submitted to Medicare, per the PAR, likely meets applicable Medicare coverage, coding, and payment rules.
Preferred Submission Method: NGSConnex
NGSConnex is the preferred method for submission of PARs. Hospitals are encouraged to use NGSConnex to submit the PAR. 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.
Part B NGSConnex users are unable to initiate or check status of PARs via NGSConnex. This functionality is only available to Part A users. If you are a Part B user and also have access to and perform work for Part A provider accounts, you will need to add your Part A provider accounts to your NGSConnex User ID. To add additional provider accounts to your NGSConnex User ID, refer to the NGSConnex User Guide, My User Profile section, Update Your Access under Request New Access.
Unique Tracking Number
Each UTN is valid for one claim/one date of service and is valid for 120 days. The decision date is counted as the first day of the 120-day count. Each procedure requires a new prior authorization request regardless of whether the next service falls within or outside of 120 days.
The UTN 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.
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 prior authorization request with several potential service codes. Please note that the documentation should support the need for all of the services requested.
Posted 7/23/2020