Dr Granger has ordered an EKG (Electrocardiogram )for Mrs Brown . Her insurance company requires a...

Dr Granger has ordered an EKG (Electrocardiogram )for Mrs Brown . Her insurance company requires a prior authorization for this procedure your coworker has completed the request form and explained each step

Expert Solution

Before submitting a prior authorization request for an ECG, a provider must have a completed SMPA (Special Medical Prior Authorization ) Request Form that has been signed and dated by a physician.

The completed SMPA Request Form must include the procedure codes and numerical quantities for the services requested. The completed SMPA Request Form with the original dated signature must be maintained by the prescribing physician in the client’s medical record.

The SMPA (Special Medical Prior Authorization) Request Form must include all of the following information, which is related to medical necessity:

1) Procedure requested (CPT)

2) Diagnosis

3) Treatment history

4) Treatment plan

Prior authorization requests submitted by paper must be faxed or mailed with the completed SMPA Request Form to the SMPA department and a copy of the signed and dated form must be retained in the client’s medical record.

Nightingale answered 2 years ago

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