Prior Authorization Outpatient Department Claim Billing
Providers may observe an increase in claim denials for PA services due to a mismatch of information provided on the PAR compared to the information supplied on the claim.
Prior Authorization Requests
Please review each PAR for accuracy prior to submission. The UTN will be created with the elements provided. If an error with a PAR submission is identified, please submit a new request with the correct information.
Claim Corrections
Claims with PA services will be denied if the beneficiary’s name and MBI, provider PTAN and NPI, performing physician and NPI, or procedure information do not match the information provided on the corresponding PAR. For claims processing, reference the PAR submitted and ensure all elements on the PAR are an exact match to the claim.
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Posted 7/18/2025