Article Detail - JE Part B
ACT Questions and Answers - September 16, 2020
The following questions and answers (Q&As) are cumulative from the Prior Authorization Ask the Contractor Teleconference (ACT). Some questions have been edited for clarity and answers may have been expanded to provide further details. Similar questions were combined to eliminate redundancies. If a question was specific just for that office, Noridian addressed directly with the provider. This session included Medicare program updates, pre-submitted questions, and questions posed during the event.
Q1: Have you received feedback that the portal is not listing status updates by providers? For example, we have received feedback from providers that when they go to the portal to check the status of their Prior Authorization Request (PAR), the portal lists a “No Results” status.
A1: Providers should be able to see all requests on the portal. If they send in by fax or mail, it will take up to 4 business days to be visible on the portal, as we need to manually key in the requests.
Q2: Will Noridian request additional criteria for re-treatment PAR requests for J0585 should a patient need to continue treatment?
A2: Noridian will not request additional criteria for re-treatment Prior Authorization requests. A new PAR will need to be submitted for continuation of treatment as the UTN is only valid for 120 days.
Q3: We are getting a lot of contradicting information. We have called Noridian and they state that Medicare Part A is to get the prior authorization, is it the hospital or the physician?
A3: The facility needs to get the prior authorization; however, the physician can send it in as well, but the physician needs to get the hospital NPI and information to send on behalf of the hospital.
Q4: Is CPT 61783 a covered service when done?
A4: This question was answered offline since this ACT is geared towards Prior Authorization. The answer provided: Use of CPT 61783 and 20985, have been determined to be NOT appropriate in cases where screws and/or other hardware are applied to the spine. All spinal procedures will be considered inappropriate for its separate payment, due to the lack of compelling literature support, and such claims will be denied as not proven effective. Please see Stereotactic Computer Assisted Volumetric &/ or Navigational Procedure (L36133).
Q5: Why would we see on the initial procedure that the hospital is denied for no prior authorization, but the physician is getting paid. We did not have a prior authorization for the procedure. All these procedures took place after July 1st, 2020.
A5: The physician should not be getting paid for the services that are on the list. For those claims that did allow payment for the rendering provider, a recoupment will be initiated. The specifics are still being worked out with CMS.
Q6: We are getting a lot of non-affirmations stating documentation does not have the patient identifier on all pages.
A6: All pages need at least two patient identifiers on the actual documentation being submitted. Please make sure this is on there. Double check with those handling their requests that those identifiers are on each page.
Q7: Will the date be retroactive if there was no prior authorization and the physician was paid, will CMS take back the money?
A7: We are still awaiting CMS direction on this matter.
Q8: We are receiving an error when uploading on the Noridian Medicare Portal (NMP). It’s not passing the virus scan. Is this a known issue?
A8: This is a known issue and the NMP team is working on it. There is no estimated time when it will be available yet.
Q9: Can we submit via fax?
A9: Yes, there is the option to submit via fax.
Q10: Will a private clinic not have to submit prior authorizations?
A10: If the clinic is billing on a type of bill 13X and on a UB-04 claim, then a prior authorization is needed. Providers can check with the billing department.
Last Updated Wed, 14 Oct 2020 18:59:22 +0000