BHW Provider — Prior Authorization (CRD · DTR

Prior Authorization

The CMS Interoperability & Prior Authorization Final Rule (CMS-0057-F) workflow, at the point of care: CRD — is prior auth required? · DTR — what documentation the payer needs · PAS — assemble & submit the request.

Is prior authorization required?

CRD

Payer

Code (CPT/HCPCS)

Diagnosis (ICD-10)

Units

Enter a payer + code to check.

Documentation the payer will require

DTR

The note check below is local documentation readiness, not a substitute for the payer's DTR questionnaire. Use Fetch payer questionnaire after entering the live-exchange details.

Check a code, then paste the note.

Authorization tracking

Renewal

Once an authorization is granted, track its span. Carelon (PBHS) requires the continued-stay/concurrent request before the last authorized day; this flags the 30/14/7-day reminders and the determination turnaround.

Auth start

Last authorized day

Review type

Enter the authorization span to track renewals.

Prior authorization request

PAS

Draft

Submitted

Pending

Approved / Denied

Live exchange details · required for CRD, DTR, PAS submission, and inquiry

Patient first name

Patient last name

Date of birth

Member ID

Group number (if applicable)

Requested service date

Rendering provider

Rendering provider NPI

BHW organization NPI

Assemble the request to preview the PAS payload.