Common Part B ASC Demonstration Questions and Answers - JF Part B

Q1. Is the ASC responsible for the authorization? Or is the physician of service responsible?
A1. Either the ASC or the servicing physician is responsible for submitting the prior authorization.

Q2. How do I get Part B 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 partbpriorauth@noridian.com.

Q4. What types of associated services will be denied when a service subject to prior authorization is denied?
A4. Associated/related (professional) services will be denied when there was a non-affirmation prior authorization request decision for the ASC service(s), or when the ASC facility claim was denied after prepayment review. These associated services include but are not limited to services such as anesthesiology services and/or physician services.

Q5. Should physicians and other associated providers submit the UTN on their claims?
A5. No. As part of this demonstration, ASC facility providers should include the UTN on their claim, as this prior authorization demonstration is only applicable to ASC facility services, or they will be subject to prepayment review. Other billing practitioners should submit their claims as usual; however, claims related to/associated with services in this prior authorization demonstration will not be paid if the service subject to prior authorization or pre-payment review is not eligible for payment.

Q6. Can I email my PA request?
A6. No. Noridian does not accept PA requests via email. You can submit prior authorization requests by mail, fax, esMD or uploading onto the NMP.

Q7. How long is my provisional affirmation Unique Tracking Number (UTN) good for?
A7. 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.

Q8. What designates a facility as an ASC?
A8. This demonstration will include ASCs that provide certain services in place of service 24 (ASC), type of service F (Ambulatory Surgical Center (Facility Usage for Surgical Services)), specialty code 49 (ASC), and are enrolled in the Medicare Fee For Service program.

Q9. What information is required on a request?
A9. To submit a prior authorization request for the ASC setting, please include the following required information:

• Beneficiary Information (as written on their Medicare card), ASC Information, Physician/Practitioner Information, Requestor Information, CPT/HCPC Code(s), Place of Service, Type of Service, Provider Specialty Code, Units of Service, Indicate if request is initial or subsequent review, Indicate if the request is expedited and the reason why.

Please refer to the ASC Operational Guide Chapter 3, section 1 - General PAR Documentation for further information on additional data elements that must be included with a PAR submission.

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. 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. For further details on rejections, please refer to the ASC Operational Guide Chapter 4, Section 1.3 - Rejected PAR.

Q13. What if the procedure has already been performed?
A13. Prior authorization cannot be requested retroactively. If the procedure has already been performed, the provider should submit the claim, which will be held by the MAC for prepayment medical review. An Additional Documentation Request (ADR) will then be issued to obtain medical records supporting the billed procedure.

Q14. I received an Additional Documentation Request (ADR) for prepayment medical review, what are my next steps?
A14. Prepayment medical record review means that the MAC will make a claim determination before claim payment using the standard Medicare prepayment medical record review process. The MAC will stop the claim prior to payment and send the ASCs an Additional Documentation Request (ADR) letter through the US Postal Service and/or electronically. The ASCs will have 45 days to respond to the ADR with all requested documentation via: Noridian Medicare Portal, Fax, Mail, or esMD. The MAC will have 30 days to review the documentation and render a claim determination.

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 partbpriorauth@noridian.com to request a re-review of the request. If the decision is upheld, you must proceed with a standard resubmission.