Prior Authorizations (Part B) - Portal Guide
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