Common Part A OPD Prior Authorization Request Questions and Answers - JF Part A

Q1. When should I submit a prior authorization request?
A1. Prior authorization requests (non-expedited) can require up to 7 calendar days for a decision. Expedited prior authorization requests can require up to 2 business days, not including weekends or holidays. It is best practice to plan and submit prior authorization requests as soon as you know the surgical date to allow time for resubmission if necessary. Each provisional affirmation is valid for 120 calendar days including the date of decision.

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 Noridian Medicare Portal (NMP) registration. Once registration is submitted, the hospital's NMP admin must approve the request. Further information can be located in the Noridian Portal Guide.

Q3. How can I check the status of my PA request?
A3. Prior authorization requests can require up to 7 calendar days for non-expedited requests and up to 2 business days, not including weekends or holidays, for expedited requests. You can review status updates on the NMP by calling the Provider Contact Center, or by e-mailing partapriorauth@noridian.com.

Q4. How do I confirm Noridian received my faxed PA request?
A4. Faxed requests may take 1 to 4 business days to appear in the clinical review queue. For faster processing and real-time updates on submissions and decisions, we strongly recommend submitting prior authorization requests through the Noridian Medicare Portal (NMP).

Q5. Can I email my PA request?
A5. No. Noridian does not accept PA requests via email. You can submit prior authorization requests by mail, fax, esMD or uploading onto the NMP.

Q6. How long is my provisional affirmation Unique Tracking Number (UTN) good for?
A6. A Unique Tracking Number (UTN) is valid for 120 calendar days including the date the decision was made. 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 the physician changes, is a new prior authorization required?
A7. No, a new prior authorization is not needed if only the physician's NPI/PTAN changes. A new prior authorization is required if the facility's NPI/PTAN changes. Unique tracking numbers (UTNs) are valid for 120 days including the decision date.

Q8. If the facility's PTAN or NPI changes, is a new prior authorization needed?
A8. Yes, a new prior authorization is required when there is a change in the facility's PTAN or NPI.

Q9. Why can't I submit a prior authorization under Part B in the Noridian Medicare Portal?
A9. For Medicare Part A prior authorization, ensure the facility's PTAN and NPI are Part A-specific. When working with the hospital billing department, confirm you're using their Part A-not Part B-credentials.

The Noridian Medicare Portal supports both Part A and B, but access is role specific. Part B users must obtain approved Part A access to submit on behalf of a Part A OPD facility.

To request access, contact your jurisdiction's Provider Contact Center. Additional guidance is available in the Noridian Portal Guide.

Q10. What qualifies as an expedited prior authorization request?
A10. Expedited review (decision within 2 business days) can be requested in instances when waiting the standard 7 calendar days could seriously harm the life or health of the patient. The expedited request must include justification showing that the standard timeframe would not be appropriate. If the Medicare Administrative Contractor (MAC) determines that the request does not substantiate the need for an expedited review, notification would be provided, and the decision would be communicated within the 7 calendar days.

Q11. What should I do after receiving a non-affirmation?
A11. You may resubmit the request with all original 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 when resubmitting.

Q12. Why was my prior authorization request rejected, and what are my next steps?
A12. Rejections occur when required information is missing or incorrect (e.g., invalid facility PTAN/NPI, incorrect patient info, missing identifiers, or non-covered codes, etc.). Review your decision letter for the rejection reason(s). Based on the reason(s) 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 been performed?
A13. Prior authorization is not available retroactively. If the procedure has already occurred, the provider must follow the appeals process.

Q14. Can I request a peer to peer if I disagree with my prior authorization request decision?
A14. No, peer-to-peer review is not available. However, you may resubmit the request with additional documentation as needed to help support and prove medical necessity of the ordered procedures -there is no limit on resubmissions.

Q15. What if I believe the non-affirmation or rejection determination on my request is incorrect?
A15. If you believe your prior authorization was non-affirmed or rejected in error, or has inaccurate information, you may contact partapriorauth@noridian.com to request a re-review of the request. If the decision is upheld, you must proceed with a standard resubmission.