I need to request a prior authorization for a physician in a group practice. Do I use the groups NPI or the physicians NPI when requesting the PA?
The prior authorization should be requested using the rendering (servicing) provider’s NPI. Do not request the prior authorization using the NPI for the group practice. What do I do about a prior authorization (PA) opened under an existing API/NPI when I enroll with a new NPI? If you have prior authorizations opened under an existing API/NPI and you enroll a new NPI, you will need to contact KePro and request that a new PA be opened under the new NPI. This same process was in place prior to the NPI when a provider would enroll with an additional Medicaid Provider Identification Number (PIN). A request had to be made open to a new prior authorization under the new PIN, and close the original prior authorization under the old PIN, before the claim could be billed under the new PIN.
Related Questions
- Does sending the requesting physician an approval of a request for authorization mean that payment must be made for the authorized service?
- What do I do about a prior authorization (PA) opened under an existing API/NPI when I enroll with a new NPI?
- Can one physician in a group request a practice review if the other physicians do not wish to participate?
