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Revisions occur when a provider requests changes in the original authorization. A change may be requested in the service through date, the number of units requested, line items to be added or removed or the provider. The “service through” date cannot be more than 365 days later than the “service from” date. The original review need not have any denials- for example the provider may just need to increase the number of units requested. A revision may also be used to reduce the number of units authorized, or to delete a procedure which was previously authorized, if that is what the provider intends to do. A revision request must have in the lower right corner of the PAR form (Box 31) the seven-character [letter, followed by six digits] authorization number for “PA Number Being Revised.” It is important to know that a PAR revision REPLACES THE ORIGINAL PAR. It does not “add to” what was originally authorized, but replaces what was originally authorized. Important: A revision should show the TOTAL number of units requested, including the original review. For example if 10 units were authorized originally and the provider wants five more units, the revision should request 15 units. If the revision request were to only show five units, the total number of units authorized would be reduced to five. Similarly, if the original PAR authorized two different procedure codes and a third procedure code is needed, the revision should list all three procedure codes. CFMC prepared this material with
input from the Colorado Department of Health Care Policy and
Financing. The contents do not necessarily reflect CDHCPF
policy. |
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