Prior Authorizations - RSNAT

Available For: Part B

Part B users may submit a request for a Prior Authorization for RSNAT services by completing the Prior Authorization Request Form.

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

Submit New Prior Authorization Request

Provider/Supplier Details

Directions: Choose the Provider/Supplier Details of the ambulance supplier for which you are submitting, and the Unique Tracking Number (UTN) will be assigned. Your NMP account must be registered with this information to review the request after submission.

  • TIN or SSN
  • NPI
  • PTAN
  • Program - Ensure MEDB is selected

Beneficiary Details (As it appears on Medicare Card)

Directions: Enter the beneficiary information as it appears on their Medicare card. Ensure all submitted medical records have the same spelling and date of birth as entered.

  • Medicare Number
  • First Name
  • Last Name
  • Date of Birth
  • State of Residence (Not required)
  • Sex (Not required)

Requestor Details

Directions: The requestor is the person that is submitting the request, this could be the office manager, prior authorization specialist, etc. The clinical reviewer will contact the requestor, if needed.

  • Requestor Full Name/Provider Name
  • Requestor Phone
  • Requestor Email Address - Updates about RSNAT and Prior Authorization may be sent if included.
  • Requestor Fax Number (Not Required)
  • Requestor Address
  • Requestor City
  • Requestor State
  • Requestor Zip

Facility/Ambulance Supplier Details

Directions: Enter the Ambulance supplier information as in the previous section: Supplier/Provider Details. This must be the same information as entered above.

  • Name
  • PTAN
  • NPI
  • Address (Not Required)
  • City (Not Required)
  • State (Not Required)
  • Zip (Not Required)
  • Physician/Practitioner Fax Number (Not Required)

Prior Authorization Request Details

  • Prior Auth Request Type - Choose RSNAT
  • Procedure Code - Enter transport code on one line only (A0428 or A0426). DO NOT include A0425. Include origin and destination modifier all together without spaces (Example: NJJN or RHHR)
  • Diagnosis Code Details (Not required, may enter 0 or leave blank)
  • Place of Service - (Not Required)
  • Type of Service - (Not Required)
  • Specialty Code - (Not Required)
  • Anticipated Date of Service - The requested start date for the requested period (60 days unless otherwise indicated on the uploaded RSNAT Coversheet)
  • Is this an Initial Request or a Resubmission - Select Initial Request or Resubmission. If Resubmission, enter Previous UTN.
  • Number of Transports Requested - Enter the number of one-way trips requested during the requested period. Round Trip = 2 transports

Upload Supporting Document

Ensure all medical records have accurate name and date of birth.

File size is limited to 70 MB.

File types supported are GIF, JPG, JPEG, TIF, TIFF, DOC, DOCX, XLS, XLSX, PDF. File name is limited to 40 characters and should help the user identify the document and its purpose at a later date.

Use the RSNAT Coversheet.

Tip
If multiple documents are needed for supporting documentation, combine all files into one file (if under 70 MB in size). This will eliminate the need for multiple uploads.
  • Document Name - Limited to 40 characters length.
  • Selected File - Browse your computer for the documentation.

Once all information is completed and documentation is attached, 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. A Prior Authorization Request Status inquiry will need to be performed in order to find the request to upload the additional documentation.

To view the status or decision of a Prior Authorization, perform a Prior Auth Inquiry. Status inquires may be performed after 15 minutes of submission.

Prior Authorization Status Inquiry

Part B users may check the status of Prior Authorization requests, view the reviewer notes, and add/view related documents. Note: Allow 15 minutes after initial request has been submitted to view the status.

Inquiry

Provider/Supplier Details

Directions: Choose the Provider/Supplier Details as entered in the submission sections: Provider Supplier Details and Facility/Ambulance Supplier Details. Your NMP account must be registered with this information to view the submission.

  • TIN or SSN
  • NPI
  • PTAN
  • Program - Ensure MEDB is selected
Beneficiary Details (As it appears on Medicare Card)

Directions: Use the Medicare Number submitted on the Prior Authorization request.

  • Medicare Number
  • First Name
  • Last Name
Prior Authorization Request Details
  • HCPCS (Enter the CPT/HCPCS code that was used on the request)

Choose Submit Inquiry.

Response

The following information will be provided:

  • Unique Tracking Number
  • Reference Number
  • Receipt Date
  • Complete Date
  • Review Status
  • Decision
  • View Notes - View notes from clinical reviewer
  • Related Documents - Add or view documents related to the request. Additional supporting documentation may be uploaded after 15 minutes after the initial request.
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