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Table of Contents
1. Introduction 1
2. System Requirements 2
3. Preparation for PA Submission Process 2
4. Trading Partner 2
5. Prior Authorization Submission 4
5.1 Patient Roster or Primary Care Roster 4
5.2 Authorization Submission 5
6. Submit Prior Authorization 8
7. Authorization Confirmation 16
8. Add Attachments to Prior Authorization 18
9. Prior Authorization Cover Sheet 19
10. View Authorization Status 20
10.1 View Attachments 24
11. Print Detail 25
Appendix A. CT and PET CPT Procedure Codes 27
Appendix A. CT and PET CPT Procedure Codes 27
Figure 4 1: Trading Partner Sign In 3
Figure 5 2: Form Entry– Authorization Submission 4
Figure 5-2: Patient Roster 5
Figure 5-3: Primary Care Roster 5
Figure 5 4: Billing Provider 6
Figure 5 5: Member Search 6
Figure 5 6: Member Search Results 7
Figure 6 3: PA Detail Screen 8
Table 1: Authorization Information Tab 9
Figure 6 4: Rendering Provider Search 9
Figure 6 5: Provider Search Results – With Rendering Providers 10
Figure 6 6: Provider Search - Without Rendering Providers 11
Table 2: Diagnosis Fields 12
Figure 6 7: Search for Diagnosis Code 12
Figure 6 8: Diagnosis Search 12
Figure 6 9: Diagnosis Search Results 13
Figure 6 10: Diagnosis Description 13
Table 3: Field Name and Field Description 14
Figure 6 11: Service Code Search 14
Figure 6 12: Service Code Search Window 14
Figure 6 13: Service Code Search Results 15
Figure 6 14: Service Line Example 15
Figure 6 15: Miscellaneous Information 16
Figure 6 16: Notes 16
Figure 7 17: Confirmation Page 17
Figure 7 18: View Appeal Rights 18
Figure 8-1: Add Attachment 19
Figure 9-1: Prior Authorization Cover Sheet 20
Figure 10 19: Form Entry-Authorization Status 21
Figure 10 20: Authorization Search 22
Figure 10 21: Authorization Status 22
Table 4: View Authorization Detail Functions 22
Table 5: Prior Authorization Disposition Codes 23
Figure 10 22: View Authorization Detail 24
Figure 10 23: View Attachment Button 24
Figure 10 24: View Attachment 25
Figure 11 25: Print Detail 25
Figure 11 26: Authorization Detail 26
Table 6: CT and PET Codes 27