On 10/25/2023, the Board held a webinar to provide updates and answer questions.
- The Board clarified that only the reviewer who made the PAR decision can override the decision. Claims examiners cannot override a level 2 decision.
- The Board doesn’t take a stance on the exact method payers should use to handle PARs for unestablished body parts. A payer may either:?- approve without prejudice. or;- or may provide that information to a Level 2 reviewer who can then conduct a medical necessity review, but also deny for the non-established body part.
- Providers should not be resubmitting already denied PARs unless there is a material change in circumstances that would now require the treatment.If you see a pattern where providers are repeatedly resubmitting - send an email to the medical director’s office ([email protected]), who will have the provider compliance committee review and potentially contact that provider.
- There is not an official time period concerning how long a PAR approval or denial is valid. The decision remains in effect until their is either:- material change in the patient circumstances. or;- the decision is overturned by the Board
