Claims with Information in the Prior Authorization Field Could be Subject to Rejection

UPDATE – Additional Clarification – Claims with Information in the Prior Authorization Field Could be Subject to Rejection

Currently, whenever a prior authorization is needed for a service, the prior authorization number is reported in the electronic claim file in loop 2300 or 2400 in the REF segment with a G1 qualifier.  CMS has not required this field in the past, but changes were made recently to allow the use of the prior authorization field in unique circumstances in the future.  For Part B, the prior authorization may be reported in loop 2300 or 2400. This is a change from the notification that the information could only be reported in loop 2400.  Claims containing invalid values in the prior authorization fields are subject to rejection.  If a claim is rejected for an invalid value in the prior authorization field, providers should remove the invalid value and resubmit the claim.

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