Prior Authorizations (Part A) - Portal Guide

Available for: Part A

Submit New Prior Authorization Request

Part A users may submit a request for a new Prior Authorization request by completing and uploading the Prior Authorization coversheet. As of June 17, 2020, Prior Authorizations are only required for certain Hospital Outpatient Department (OPD) services.

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 the Beneficiary Details
  • Medicare Number
  • First Name
  • Last Name
  • Date of Birth
• Enter or Choose the Requestor Details (* indicates the field is required)
  • Requestor Name*
  • Requestor Phone
  • Requestor Email Address
  • Requestor Fax Number
  • Requestor Address
  • Requestor City
  • Requestor State
  • Requestor Zip Code
• Enter the Facility Details
  • Facility Name
  • Facility NPI (will auto-populate from the Provider/Supplier Details)
  • Facility PTAN (will auto-populate from the Provider/Supplier Details)
  • Facility Address
  • Facility City
  • Facility State
  • Facility Zip Code
• Enter or Choose the Physician/Provider Details (* indicates the field is required)
  • Provider Name*
  • Provider PTAN*
  • Provider NPI*
  • Provider Address
  • Provider City
  • Provider State
  • Provider Zip Code
• Complete the Prior Authorization Request Details
  • Procedure Code
  • Number of Units
  • Anticipated Date of Service
  • Diagnosis Code
  • Type of Bill
  • Initial Request or Resubmission?
  • Expedited Request?
• 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.

Prior Authorization Request Status

Part A users may check the status of Prior Authorization requests, 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
• 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

Prior Authorization Exemption Inquiry

Inquiry

• Choose Exemption Inquiry tab under Prior Authorizations.
• Choose TIN, NPI and PTAN if needed.
• Choose Submit Inquiry

Response

The response page provides a summary of the provider information that was used in the search.

Below that the Portal provides the following:

• Letter Date
• Reference Number
• Download Letter
  • Choose the download link to few a copy of the Prior Authorization Exemption letter.