Submitting an ASC Prior Authorization Request - JE Part B
Submitting an ASC Prior Authorization Request
The PAR must be submitted before the service is provided and before the claim is filed. Submissions after the service will not be accepted and claims without prior authorization will undergo prepayment review.
Requesters must include the following data elements in all PARs to avoid potential delays in processing. Your MAC may request additional, optional elements for submission of the PAR.
Access the Prior Authorization Request Coversheet on the Forms page.
Note: Only one date of service per request.
Initial Submission Documentation
Beneficiary Information (as written on their Medicare card):
- Beneficiary Name
- Beneficiary Medicare Number (also known as the MBI)
- Beneficiary Date of Birth
ASC Information:
- Name of facility
- PTAN/CCN
- Facility Address
- Facility National Provider Identifier (NPI)
Physician/Practitioner Information:
- Physician/Practitioner's Name
- Physician/Practitioner's NPI
- Physician/Practitioner's PTAN
- Physician/Practitioner's Address
- Physician/Practitioner's Fax Number (optional)
Requester Information:
- Requester Name
- Requester Phone Number
- Requestor Email Address
- Requestor Fax Number (refer to your MAC jurisdiction)
Other Information:
- HCPCS Code(s)
- Place of Service
- Type of Service
- Provider Specialty Code
- Units of Service
- Indicate if the request is an initial or subsequent review
- Indicate if the request is expedited and the reason why
Resubmission(s) Documentation
In addition to the required PAR documentation in the Initial Submission section, the resubmission of the PAR should contain an exact match of the beneficiary's first name, last name, date of birth, and the unique tracking number (UTN) associated with the previous submission.
Sending a Prior Authorization Request
Requesters have the following options for submitting PARs to Noridian:
- Fax
- Electronic Submission of Medical Documentation (esMD), content type 8.7
- Noridian Medicare Portal (CMS-approved electronic portal)
For more information about esMD, see CMS Electronic Submission of Medical Documentation (esMD) webpage or contact Noridian.
