CGS Administrators, the jurisdictions B and C DME MAC, has published a prior authorization reminder to home medical equipment suppliers who bill Medicare.
As of June 1, exempt suppliers — defined as suppliers who didn’t opt out of the process — should have stopped submitting prior authorization requests to the DME MACs “All other suppliers must continue to submit prior authorization requests,” CGS said.
The two DME MACs — Noridian Healthcare Solutions is the contractor for jurisdictions A and D — began determining in January which suppliers would be offered “exemption status.” Noridian and CGS then sent written notifications to suppliers in April regarding their exemption statuses.
Suppliers were required 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 the DME MACs’ exemption status.
Those suppliers who are exempt should not send prior authorization requests, as 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 as the contractors check for continued compliance.
That new exemption cycle starts June 1, 2027, with participating suppliers being notified of their status in April 2027.
