Submitting a Prior Authorization Request (RSNAT)

Requesters are encouraged to include the following data elements in all Prior Authorization (PA) requests to avoid potential delays in processing.

Initial Submission Documentation

Beneficiary Information (as written on their Medicare card):

  • Beneficiary Name
  • Beneficiary MBI
  • Beneficiary Date of Birth

Certification Physician/Practitioner Information:

  • Physician/Practitioner name
  • Physician/Practitioner National Provider Identifier (NPI)
  • Physician/Practitioner address
  • Physician/Practitioner Provider Transaction Access Number (PTAN)

Ambulance Supplier Information:

  • Ambulance supplier name
  • Ambulance supplier NPI
  • Ambulance supplier (PTAN)
  • Ambulance supplier address

Requester Information:

  • Requester Name
  • Requester Phone Number
  • Requester Address

Other Pertinent Information:

  • Submission date
  • Number of transports requested
  • HCPCS code
  • Requested start date of the prior authorization period
  • Indicate if the request is an initial or resubmission review
  • Indicate if the request is expedited and the reason why
  • State where the ambulance is garaged

Resubmission(s) Documentation

In addition to the required PA request documentation in the Initial Submission section, the resubmission of the PA request should contain an exact match of the beneficiary's first name, last name, and date of birth to the previous submission.

Implementation of Prior Authorization

Noridian will start accepting PA requests for the first initial services on January 18, 2022, for services provided beginning on or after February 1, 2022.

Sending a Prior Authorization Request

Requesters have the following options for submitting PA request to Noridian:

Submissions through esMD available after February 1, 2022. For more information about esMD, see CMS Electronic Submission of Medical Documentation (esMD) webpage or contact Noridian.

Resources

 

Last Updated Dec 09 , 2022