The Process of Prior Authorization
Change Request (CR) 9940 updates the Centers for Medicare & Medicaid Services (CMS)
“Program Integrity Manual” to permit the MACs to conduct prior authorization processes,
as so directed by CMS through individualized operational instructions. As of January 2017,
Prior Authorization of Certain Durable Medical Equipment, Prosthetic, Orthotic, and Supply
Items, frequently subject to unnecessary utilization, is the only permanent (nondemonstration) prior authorization program approved for implementation.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 20, 2017
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