Medical review
Paperwork (PWK)
Learn how PWK, the paperwork segment of the X12N version 5010, allows providers to submit medical documentation with their initial claim.
Prior authorization (PA) program for certain hospital outpatient department (OPD) services - submitting the prior authorization request (PAR)
View these submission guidelines when submitting prior authorization requests for certain hospital outpatient department services.
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Prior authorization (PA) program for certain hospital outpatient department (OPD) services - submitting the prior authorization request (PAR)
View these submission guidelines when submitting prior authorization requests for certain hospital outpatient department services.
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Checklist: Pulmonary rehabilitation services
This checklist is being provided as a tool to assist providers when responding to medical record documentation requests for pulmonary rehabilitation services.
Prior authorization for hospital outpatient department services: Don’t wait too long to submit your prior authorization requests
When submitting prior authorization requests, be aware of response timeframes and documentation guidelines.
Prior authorization for hospital outpatient department services: Don’t wait too long to submit your prior authorization requests
When submitting prior authorization requests, be aware of response timeframes and documentation guidelines.
Checklist: Nursing home
This checklist is being provided as a tool to assist providers when responding to medical record documentation requests for nursing home services.
Instructions for completing the prior authorization request (PAR) coversheet for repetitive scheduled non-emergency ambulance transport
Learn how to complete the the prior authorization request (PAR) coversheet for repetitive scheduled non-emergency ambulance transports.