Prior Authorization Process (Five Original Categories)

Proposed Prior Authorization Process and Requirements for Certain Hospital Outpatient Department (OPD) Services (CMS-10711)

OMB: 0938-1368

IC ID: 237862

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Prior Authorization Process (Five Original Categories)
 
No Modified
 
Mandatory
 
42 CFR 419.80-83

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

8,982 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   70 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 194,785 0 43,334 0 0 151,451
Annual IC Time Burden (Hours) 108,108 0 0 0 0 108,108
Annual IC Cost Burden (Dollars) 292,175 0 292,175 0 0 0

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