Prior Authorizations (Part A) - Portal Guide
Prior Authorizations (Part A)
Available for: Part A
Submit New Prior Authorization Request
Part A users may submit a request for a new Prior Authorization request by completing and uploading the Prior Authorization coversheet. As of June 17, 2020, Prior Authorizations are only required for certain Hospital Outpatient Department (OPD) services.
|Blepharoplasty, Eyelid Surgery, Brow Lift and related services||15820 - 15823, 67900 - 67904, 67906, 67908|
|Botulinum Toxin Injection||64612, 64615, J0585 - J0588|
|Cervical Fusion with Disc Removal||22551, 22552|
|Implanted Spinal Neurostimulators||63650|
|Panniculectomy, Excision of Excess Skin and Subcutaneous Tissue (Including Lipectomy) and related services||15830, 15847, 15877|
|Rhinoplasty and related services||20912, 21210, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30520|
|Vein Ablation and related services||36473 - 36476, 36478, 36479, 36482, 36483|
Choose Prior Authorizations from the Main Menu and then the Submit New Prior Auth Tab.
- Select the Provider/Supplier Details
- TIN or SSN
- Enter the Beneficiary Details
- Medicare Number
- First Name
- Last Name
- Date of Birth
- Enter or Choose the Requestor Details (* indicates the field is required)
- Requestor Name*
- Requestor Phone
- Requestor Email Address
- Requestor Fax Number
- Requestor Address
- Requestor City
- Requestor State
- Requestor Zip Code
- Enter the Facility Details
- Facility Name
- Facility NPI (will auto-populate from the Provider/Supplier Details)
- Facility PTAN (will auto-populate from the Provider/Supplier Details)
- Facility Address
- Facility City
- Facility State
- Facility Zip Code
- Enter or Choose the Physician/Provider Details (* indicates the field is required)
- Provider Name*
- Provider PTAN*
- Provider NPI*
- Provider Address
- Provider City
- Provider State
- Provider Zip Code
- Complete the Prior Authorization Request Details
- Procedure Code
- Number of Units
- Anticipated Date of Service
- Diagnosis Code
- Type of Bill
- Initial Request or Resubmission?
- Expedited Request?
- Supporting Documentation may be uploaded to support the Prior Authorization
- File size is limited to 70 MB
- File types supported are GIF, JPG, JPEG, TIF, TIFF, DOC, DOCX, XLS, XLSX, PDF
- Choose Submit
Once the request has been submitted, a Reference Number will be provided. Additional supporting documentation may be uploaded after 15 minutes to allow the initial request to process.
Prior Authorization Request Status
Part A users may check the status of Prior Authorization requests, view the reviewer notes, and add/view related documents.
- Select Prior Authorizations from home page then choose Prior Auth Inquiry
- Choose TIN or SSN, NPI and PTAN combination under Provider/Supplier Details
- Enter Medicare Number and First and Last Name submitted on the Prior Authorization Request
- Enter HCPCS Code submitted on the request
The portal provides the following information:
- Unique Tracking Number
- Reference Number
- Receipt Date
- Complete Date
- Review Status
- View Notes - View notes from prior authorization request reviewer
- Related Documents - Add or View documents related to the prior authorization request
Prior Authorization Exemption Inquiry
- Choose Exemption Inquiry tab under Prior Authorizations.
- Choose TIN, NPI and PTAN if needed.
- Choose Submit Inquiry
The response page provides a summary of the provider information that was used in the search.
Below that the Portal provides the following:
- Letter Date
- Reference Number
- Download Letter
- Choose the download link to few a copy of the Prior Authorization Exemption letter.
Last Updated Thu, 23 Jun 2022 15:46:04 +0000