Available for: Part B

Submit New Prior Authorization Request

Part B users may submit a request for a new Prior Authorization request by completing the Prior Authorization Request Form. Part B Prior Authorizations are only available for HCPCS Codes A0426 and A0428.
Choose Prior Authorizations from the Main Menu and then the Submit New Prior Auth Tab.

• Select the Provider/Supplier Details
  • TIN or SSN
  • NPI
  • PTAN
• Enter or Choose the Beneficiary Details (* indicates the field is required)
  • Medicare Number*
  • First Name*
  • Last Name*
  • Date of Birth*
  • State of Residence
  • Gender
• Enter or Choose the Requestor Details (* indicates the field is required)
  • Requestor Full Name/Provider Name*
  • Requestor Phone*
  • Requestor Email Address
  • Requestor Fax Number
  • Requestor Address*
  • Requestor City*
  • Requestor State*
  • Requestor Zip Code*
• Complete the Prior Authorization Request Details (* indicates the field is required)
  • Procedure Code*
  • Modifier
  • DX Indicator
  • Diagnosis Code
  • Anticipated Start Date *
  • Initial Request or Resubmission? *
  • Expedited Request? *
    • If Yes, enter justification
  • Number of transports requested (round trip = 2 transports)*
• 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. A Prior Authorization Request Status inquiry will need to be performed in order to find the correct request.

To view the status of the request, perform a Prior Authorization Request Status inquiry. Status inquires may be performed after 15 minutes of submission. Decisions of the Prior Authorization Request will be viewable by performing a Prior Authorization Request Status inquiry.

Prior Authorization Request Status

Part B users may check the status of Prior Authorization requests, view the reviewer notes, and add/view related documents. Note: Please allow 15 minutes after initial request has been submitted to view the status.

Inquiry

• 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

Response

• The portal provides the following information:
• Unique Tracking Number
• Reference Number
• Receipt Date
• Complete Date
• Review Status
• Decision
• View Notes - View notes from prior authorization request reviewer
• Related Documents - Add or View documents related to the prior authorization request
  • Note: Additional supporting documentation may be uploaded after 15 minutes to allow the initial request to process.