Type of Bill Code is a Requirement for All Prior Authorization Requests
The National Government Services PA Department has seen an increase in cases that are submitted without a TOB code. PA staff conducts outreach to obtain this code; however, responses to outreach are not received timely, resulting in PAR rejection.
Only hospital outpatient department services are required to obtain prior authorization as part of this program. Other facility/provider/supplier types such as physician’s offices, critical access hospitals or ambulatory surgery centers who submit claims other than TOB 13X are not required to submit PARs.
Prior Authorization Reminder
The TOB is required to be submitted with the PAR. Please contact the HOPD prior to PAR submission to ensure the TOB is included and satisfies the HOPD requirement to avoid rejection and timely processing of your PAR.
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Posted 3/30/2023