Medical Review - JF Part B
Medical Review Frequently Asked Questions (FAQs)
Q1. We have an affirmed Unique Tracking Number (UTN) for 40 one-way trips 5/1/22 to 6/30/22, but we needed 12 more trips during the 60-day period beginning on 6/17/22. How should we proceed?
A1. Unique Tracking Numbers (UTNs) are only valid for the dates of service within the affirmed range, specific HCPCS code, and number of transports affirmed on the decision letter. There is a counter that runs each time a claim is billed with a UTN and does not allow more trips to be billed with a UTN than the number of trips affirmed. If more dates, different HCPCS or more transports are needed, an additional prior authorization request may be submitted. The new request should include all of the required documentation along with information that the previous request has run out of trips and additional trips are requested, the start date and end date (6/17/22-6/30/22 for this example), and number of additional trips requested (12 one-way trips for this example). This is the only instance where there can be overlapping dates with a previously affirmed request. A new UTN will be issued with the determination letter. The new UTN is only valid for the dates of service, HCPCS and number of transports indicated on the determination letter.
Q2. Who can sign a physician certification statement (PCS) for repetitive, scheduled, non-emergent, ambulance transport (RSNAT) prior authorization requests and claims?
A2. Only an attending physician, that is an MD or DO, may certify RSNAT services by signing a PCS. According to Title 42 CFR 410.40 Physician assistants (PA), Nurse practitioners (NP), Clinical nurse specialists (CNS), Registered nurses (RN), Licensed practical nurses (LPN), Social workers, Case managers, and Discharge planners are all considered individuals that can sign a Non-physician certification statement (NPCS), which is not valid for the certification of RSNAT services. Refer to Title 42 CFR 410.40 (e)(2), Special rule for nonemergency, scheduled repetitive ambulance services.
Q3. How do I know what documentation is necessary for the service or procedure I am providing?
A3. Reference the Browse by Topic link in the Noridian website. From there click on Documentation Requirements. This will give a listing of specialty/topic specific documentation requirements for many different specialties and/or services. The documentation should support medical necessity of the service being performed and support the billing/coding of the claim. Please refer to Documentation Requirements.
Last Updated Wed, 28 Sep 2022 17:39:35 +0000