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Back  RFI # 2175: Extend Authorization

Formal vs. Informal Help Informal Formal

Submitter

Dennis Zanetti

Description

Is there any ability in the 278 to 'extend' an authorization beyond asking for more visits using the HSD segment? That seems to be the only capability that is supported on an extension request. The health plan I am working with would like to be able to allow a provider to request additional services (essentially new service lines) on the authorization. Is this allowed?

Submitter Assigned Keywords

authorization extend add service 278

Response

For requesting additional services, the UM02 value = S (Revised) should be used for an event that has been previously approved. UM02 value = 4 (extension) should not be used for this example. The X217 guide defines UM02=4 as 'Indicates that this is an extension request to a prior approved service.' If new/additional services are being added, they are not considered prior approved services.
Submission 10/5/2016
Status Date 12/6/2016
Status F - Final
Primary References
Document 005010X217
Section1.12.3.1
Page33