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NCATS recipients are required to adhere to the NIH Grants Policy Statement, unless the Notice of Award states otherwise. Prior approval requests must be submitted via the eRA Commons Prior Approval Module or by email with a copy to the named Grants Management Specialist (GMS) and Program Official (PO).
Who handles submitting a request for prior authorization?
Reduction of PI/Co-PI effort of 25% or More: Any budgetary change that results in a reduction of 25% or more in the effort of the PI or Co-PI requires sponsor approval if it is a federally funded award.
What can the technician do to help expedite a prior authorization?
Prior authorization requires your doctor or provider to obtain approval from your health plan before providing health care services or prescribing prescription drugs. Without prior authorization, your health plan may not pay for your treatment or medication. (Emergency care doesnt need prior authorization.)
Who is responsible to provide the information required on the prior authorization to the third party payer?
The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patients insurance provider. As mentioned in the How does prior authorization work? section above, this will then often prompt a time-consuming back and forth between the provider and payer.
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Should an unlisted or miscellaneous code be requested, medical necessity documentation and rationale must be submitted with the prior authorization request.
May 4, 2020 Below is a high level description of the workflow for processing Category I Prior Approval Requests. For more detailed information on the steps,
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