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July 31, 2019

Prior Authorization and ADMC Status in myCGS—Understanding the Difference

With the release of version 5.5, myCGS now offers the ability to submit Prior Authorization (PA) and Advanced Determination of Medicare Coverage (ADMC) requests directly through the web portal. As part of that upgrade, myCGS now separates PA and ADMC functions—including status requests—into their own menu items and screens.

In previous versions of myCGS, there was only one screen to check status for both PA and ADMC. That is no longer the case—as shown in the image below, PA and ADMC now have their own individual screens for both status and submission. If you attempt to find the status of an ADMC case on the PA status screen, your search will result in an error (you may receive a message saying the HCPCS is invalid or that the search had no results). Likewise, if you search for a PA case on the ADMC status screen, you will receive a similar error message. Therefore it’s important to always make sure you are on the correct screen when searching for either PA or ADMC requests.

Screen Shot

Complete instructions for PA and ADMC status and submission are available in the myCGS User ManualPDF. For information about PA and ADMC, be sure to refer to the DME MAC Jurisdiction B Supplier Manual, Chapter 9PDF.

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