Prior Authorizations (DME) - Portal Guide

Available For: DME

Prior Authorization Request Status

DME suppliers may check the status of Power Mobility Device (PMD), Pressure Reducing Support Surfaces (PRSS), Orthoses, and Lower Limb Prosthetics (LLP) Prior Authorization Request (PAR) status, view the reviewer notes and add/view related documents.

Inquiry

• Select Prior Authorizations from home page then choose Prior Auth Inquiry
• Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
  • Note: DME Vendor End Users are required to enter a Trading Partner ID and Vendor TPID
• Enter Medicare Number and First and Last Name submitted on the Prior Authorization Request
• Enter HCPCS Code submitted on the request

Response

The portal provides the following information:

• Unique Tracking Number
• Reference Number
• Receipt Date
• Complete Date
• Review Status
• Decision
• View Notes - View notes from prior authorization request reviewer
• Related Documents - Add or View documents related to the prior authorization request

Note: Results from January 1, 2022 to current date will be available. For results prior to that date, please contact the Provider Contact Center

Submit New Prior Authorization Request

DME users may submit a request for a new Prior Authorization request. HCPCS codes available for prior authorization requests are for Power Mobility Devices (PMDs), Pressure Reducing Support Surfaces (PRSS), Orthoses and Lower Limb Prosthetics (LLP):

• PMDs - K0813 - K0816, K0820 - K0829, K0835 - K0843, K0848 - K0856
• PRSS - E0193, E0277, E0371 - E0373
• LLP - L5856, L5857, L5858, L5973, L5980, L5987
• Orthoses - L1832, L1851, L0648, L0650, L0631, L0637, L0639, L1843, L1845 and L1951

Choose Prior Authorizations from the Main Menu and then the Submit New Prior Auth tab.

• Select the Provider/Supplier Details
  • TIN or SSN
  • NPI
  • PTAN
• Enter or choose the Beneficiary Details
  • Medicare Number
  • First Name
  • Last Name
  • Date of Birth
  • State of Residence
• Enter the Supplier Details based on the facility that is requesting the Prior Authorization
  • Supplier Point of Contact
  • Supplier Name (will auto-populate from the Provider/Supplier Details)
  • Street
  • City
  • State
  • Zip
  • Supplier Phone
  • Supplier Fax
  • Supplier NPI (will auto-populate from the Provider/Supplier Details)
  • Supplier PTAN (will auto-populate from Provider/Supplier Details)
• Enter the HCPCS code the Prior Authorization is being requested for under the Prior Authorization Request Details
• Answer the following questions:
  • Will you be providing an upgraded item to the beneficiary - Yes or No (PMD Requests Only)
    • If Yes, Enter requested HCPCS code and HCPCS code of upgraded item
  • Is this an Initial Request or a Resubmission
  • Submitter - Supplier or Beneficiary
  • Would you like a copy of the decision letter sent to the beneficiary – Yes or No
  • Expedited Request? - Yes or No
    • If Yes, justification is needed to meet expedited requirements
• Supporting Documentation may be uploaded to support the Prior Authorization
  • File size is limited to 70 MB
  • File types supported are GIF, JPG, JPEG, TIF, TIFF, DOC, DOCX, XLS, XLSX, PDF.
• Choose Submit

Once the request has been submitted, a Reference Number will be provided. Additional supporting documentation may be uploaded after 15 minutes to allow the initial request to process.

To view the status of the request, perform a Prior Authorization Request Status inquiry. Status inquires may be performed after 15 minutes of submission. Decisions of the Prior Authorization Request will be viewable by performing a Prior Authorization Request Status inquiry.