Outpatient Prior Authorization Program (Part A)

What services require prior authorization with the OPD PA program? Check all that apply.

• Blepharoplasty

• Botulinum toxin injection

• Panniculectomy

• Rhinoplasty

• Vein ablation

Who is required to submit Prior Authorization request?

• Hospital Outpatient department

• Physician

• Beneficiary

• Family member

Hospital outpatient departments need to obtain Prior Authorization and what TOB (Type of Bill) do they submit?

• TOB 83X

• TOB 33X

• TOB 13X

Botulinum toxin injection documentation submission for the prior authorization request requires. Check all that apply.

• Documentation of specific site and frequency

• Support of the clinical effectiveness of injection (for continuous treatment)

• A history of migraine and experiencing frequent headaches on most days of the month

• Support of the clinical effectiveness of the injections

True or False. Documentation submission for Blepharoplasty requires visual field studies or photos?

• True

• False

True or False. Vein Ablation prior authorization request require submission of tests validating the location and level of varicostities.

• True

• False

Expedited requests can be submitted for:

• Situations that could jeopardize the life or health of the beneficiary

• Scheduling convenience

• Beneficiaries who ask for expedited

Prior Authorization requests have ___________ days to be reviewed and make a decision.

• 10 days

• 2 days

• 2 weeks

• 3 months

Validation periods for UTN (Unique Tracking Numbers) are good for:

• 1 day

• 2 weeks

• 120 days

• 12 months

True or False. A prior authorization request can be back dated to cover the dates of a procedure if a prior authorization was not obtained.

• True

• False