Prior Authorization Exemption Status Inquiry Tool
This is a self-service tool to allow both hospital or physician office staff responsible for submitting prior authorization requests (PARs), to check the exempt status of the HOPD. This tool will only recognize the hospital 6-10 digit PTAN (CCN) number. If the PTAN entered is not recognized, it is an indication that a PAR is required.
Please note: Physician, Ambulatory Surgical Center and Critical Access Hospital PTAN entries will not return results; however a PAR is not required for these facility types. Only hospital outpatient departments billing with a Type of Bill (TOB) code 13x require prior authorization.
Attention withdrawn providers: If results populated for your PTAN up until 12/10, and reentry of your PTAN now states, “No results returned for this PTAN”, you have been withdrawn from the exemption process. You may start submitting prior authorization requests as early as December 18 for dates of service on or after January 1.