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Printed Date: 9/22/2015
The Prior Authorization Demonstration for South Carolina began on December 1, 2014 and expanded to North Carolina, Virginia and West Virginia on January 1, 2016. Then the model was extended for those four states through December 1, 2020, (based on date of service). Ambulance suppliers that are not institutionally (hospital)-based that provide Part B Medicare-covered ambulance services and are enrolled as an independent ambulance suppliers will be participants. Prior authorization is a process through which a request for affirmation of coverage is submitted for review before a service is rendered to a beneficiary and before a claim is submitted for payment. Prior authorization helps ensure that applicable coverage, payment and coding rules are met before services are rendered.
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Last Updated: 9/01/2020
Applies to: Prior Authorization
Article Topics: Appeals, Redeterminations, and PTANs