Article Detail - JA DME
Suppliers Providing Spinal or Knee Orthoses That Require Prior Authorization
Suppliers who have obtained an affirmative decision on a prior authorization request (PAR) then subsequently bill with the ST modifier and include the Unique Tracking Number (UTN) received in the PAR decision letter, will receive an Additional Documentation Request (ADR) letter. 100% of claims billed with the ST modifier will be subject to prepayment review and will receive an ADR letter. This letter will be requesting all documentation again that was already submitted with the PAR. If there is no response to this letter, the claim will be denied, causing additional rework in appealing the claim.
To avoid this extra work, when suppliers have received an affirmed PAR decision and appended the UTN to the claim, the ST modifier should not be appended. Remember when the ST modifier is appended to a claim it causes the claim to BYPASS PA so it should never be submitted in addition to a PAR.
