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January 7, 2015

New Fields for Prior Authorization

The January 2015 Fiscal Intermediary Standard System (FISS) release added a new field relating to the implementation of Prior Authorization.  The field, “UTN” (Unique Tracking Number), was added to the FISS claim page 02.  At this time, home health and hospice providers are not required to enter any information into the UTN field. 

In addition, the 18-digit TREAT. AUTH. CODE field (Treatment Authorization) on FISS claim page 05, which is only applicable to home health providers, was expanded.  Immediately following the existing 18-digit field, a new 14-byte field was added. The new 14-byte field must be blank, or contain valid Medicare data.  For claims submitted in the ASC X12 837 format, when applicable, valid data must be reported in the loop 2300 REF02 (REF01=G1) segment for the ASC X12 837 claim. Hospice providers are not affected by changes to this field, at this time.

Information regarding prior authorization can be found at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Prior-Authorization-Initiatives/Prior-Authorization-Initiatives-.htmlExternal Website.

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