Prior Authorizations (Part B)

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.

 

Last Updated Fri, 22 Jul 2022 13:15:19 +0000