CGS Administrators, the jurisdictions B and C DME MAC, is reminding home medical equipment providers who bill Medicare about the June 1 change in the prior authorization process.
Starting June 1, exempt suppliers — defined as those who didn’t opt out of the process — should not submit prior authorization requests. “All other suppliers must continue to submit prior authorization requests,” CGS said.
In January, the two DME MACs — Noridian Healthcare Solutions is the contractor for jurisdictions A and D — began determining which suppliers would be offered “exemption status.” The DME MACs sent written notifications to suppliers in April regarding their exemption status.
Suppliers had to submit at least 10 prior authorization requests during the annual assessment period and had to achieve a provisional affirmation rate of 90% or higher on initial prior authorization requests to qualify for exemption status.
Suppliers who are exempt should not send prior authorization requests. The DME MACs will reject requests from exempt suppliers. Suppliers who are not exempt or who have opted out must continue to send prior authorization requests.
Currently exempt suppliers will receive additional documentation requests in January 2027 so the contractors can check for continued compliance.
The new exemption cycle would start June 1, 2027, with participating suppliers being notified of their status in April 2027.
