Common Prior Authorization Request (PAR) Questions and Answers - JF Part A

Q1. How soon should I submit a prior authorization request?
A1. Prior authorizations (non-expedited) can take up to 10 business days, not including weekends or holidays. Expedited prior authorizations can take up to 2 business days not including weekends or holidays. It is best practice to plan and submit prior authorization request as soon as you know the surgical date to allow time for resubmission of prior authorization requests if necessary.

Q2. How do I get Part A access to the Noridian Medicare Portal (NMP) to submit a prior authorization request?
A2. Providers must work with their respective hospitals to obtain their National Provider identifier (NPI), Provider Transaction Access Number (PTAN) and Tax Identification Number (TIN) for NMP registration. Once the provider requests the hospital's information be added, the hospital's NMP administration will need to approve the request. Further information can be located on Noridian's Portal Guide.

Q3. Where can I get a status update on my prior authorization request?
A3. Prior authorization requests can take up to 10 business days not including weekend and holidays for non-expedited requests and up to 2 business days not including weekend or holidays for expedited requests. You can review status updates on the NMP.

Q4. How can I confirm that Noridian received my prior authorization request sent via fax?
A4. Requests received via fax may take 1-4 business days before viewable on the NMP. Submitting prior authorization via the NMP is strongly encouraged as it displays real time results with submissions and decisions of prior authorization requests.

Q5. Can I submit my prior authorization request to an email address?
A5. No. Noridian Healthcare Solutions cannot accept email as method of receiving prior authorization request. You can submit prior authorization requests by mail, fax, esMD or uploading onto the NMP.

Q6. How long is my provisional affirmation UTN (unique tracking number) good for?
A6. UTN (unique tracking number) is valid for 120 calendar days from the date the decision was made listed on the letter. If the procedure is awarded a provisional affirmation and the procedure is NOT performed within the 120 calendar days, the provider will need to submit a new prior authorization request.

Q7. If there is a change in physician, is a new prior authorization needed?
A7. No, a new prior authorization would only be needed if the date of surgery is past 120 days from date the decision was made and the PTAN and/or NPI of facility will remain the same.

Q8. If there is a change in PTAN or NPI number, is a new prior authorization needed?
A8. Yes, a new prior authorization is required if the PTAN or NPI number of facility changes.

Q9. Why can't I request prior authorization under Part B?
A9. For the Part A prior authorization program, both the PTAN and the NPI need to be for the Medicare Part A program.

When speaking to the billing department for the hospital that the procedure will take place in, you may need to confirm or request the facility's Part A PTAN or NPI number and not their Part B PTAN or NPI.

Q10. What qualifies as an expedited prior authorization request?
A10. Expedited review (2 business days) can be requested in instances when waiting the standard 10 business day timeframe could seriously negatively impact the life or health of the patient. The expedited request must include justification showing that the standard timeframe would not be appropriate. If the MAC determines that the request does not substantiate the need for an expedited review, notification would be provided, and decision would be communicated within the standard 10 business day timeframe.

Q11. What are my next steps after receiving a non-affirmation?
A11. The requestor may resubmit another prior authorization request with all documentation to support medical necessity and any additional documentation needed as indicated in the detailed decision letter. Unlimited prior authorization resubmissions are permitted. The requestor is encouraged to include the original non-affirmed UTN on the resubmitted prior authorization request.

Q12. My prior authorization request was rejected. Why? What do I do now?
A12. Rejections result in MACs unable to move forward with reviewing prior authorization request without accurate information. Prior authorization request may be rejected for various reasons such as invalid Part A PTAN or NPI, inaccurate beneficiary information, missing two patient identifiers within the medical records, CPT or HCPCS codes requested not being part of the prior authorization program, etc. Please be sure to read your decision letter to determine reason for rejection. Based on the reason for rejection, the next steps may include resubmitting your prior authorization request with the correct and/or missing information.

Q13. What if the procedure has already taken place? Do I submit my prior authorization request?
A13. Prior authorization does not review retroactive prior authorization requests.

Q14. Can I request a peer to peer if I disagree with my prior authorization request decision?
A14. Peer to peer review is not currently an option for prior authorization as the program allows an unlimited number of resubmissions of requests to help support and prove medical necessity of the ordered procedures.

Q15. What if I think the decision of my prior authorization request is incorrect and/or the submitted documentation supports what the prior authorization was non-affirmed for?
A15. You can re-submit your prior authorization request an unlimited number of times after issued non-affirmation(s). If you believe your prior authorization was non-affirmed or has inaccurate information in error, you may contact partapriorauth@noridian.com to request re-review of the prior authorization request; however, if the non-affirmation decision is not overturned the process to re-submit would need to be followed subsequently.