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WorksheetsOutpatient Prior Authorization Program (Part A)
Total questions: 10
Worksheet time: 6mins
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
