The Centers for Medicare & Medicaid Services (CMS) requests that Medicare Administrative Contractors (MACs) sufficiently educate stakeholders about prior authorization programs, where CMS provides provisional affirmation of coverage before the claim is submitted or the medical service is provided. Requirements for contractors include holding training sessions, providing timeline information and other information on prior authorization programs, and assessing prior authorization submissions for completeness.
Subject: The Process of Prior Authorization
Title: Change Request 9940
Release Date: Jan. 20, 2017
Effective Date: Feb. 21, 2017
Implementation Date: Feb. 21, 2017
Special Notes: N/A