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Elizabeth M. Whitehorn, Director

Provider Notice issued 07/20/06

Prior Approval Number Required

To:​ Participating Durable Medical Equipment Providers ​
Date:​ July 20, 2006​
Re:​ ​Prior Approval Number Required

Effective with the date of this notice, the prior approval number that is assigned by the department will be required on claims for durable medical equipment and supplies. The prior approval number can be found on the Form HFS 3076A, Prior Approval Notification Letter generated by the department.

 

The prior approval number will be used to identify the specific prior approval on which the claim will be edited. If the procedure code requires prior approval and the prior approval number field on the claim form is blank or does not match a prior approval number on the department’s system, the claim will reject for R09, Prior Approval Required.

Instructions for Paper Claims:

On the DPA 2210, Medical Equipment/Supplies Invoice , the prior approval number must be reported in the Prior Approval Number field for each service section completed. Providers must enter the last eight digits of the prior approval number, since this field will only accommodate eight digits. The department’s system will add the first two digits when editing the field.

 

Instructions for Electronic Claims:

 

In accordance with the 837P Implementation Guide, the prior approval number must be entered at the claim level reported in Loop 2300, REF02, Prior Authorization or Referral Number. When completing the service line level in Loop 2400, if the prior approval number for the service line is different than the number reported in Loop 2300 at the claim level, enter the appropriate prior approval number at the service line level.

 

The changes discussed above have been added to the Handbook for Provider of Durable Medical Equipment and Supplies, Chapter M-200 and are available on the HFS Web site at: http://www.hfs.illinois.gov/handbooks/

 

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

 

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs