Prior Authorization (PA) Changes to Implement the Inpatient Rehabilitation Facility (IRF) Review Choice Demonstration (RCD)
The purpose of this Change Request (CR) is to make Fiscal Intermediary Shared System (FISS) and Common Working File (CWF) system changes necessary to use the PA process to implement the IRF ICD. Current logic requires specific line item service (outpatient) or procedure code (inpatient) to assign and validate the program code. This CR will modify FISS and CWF to assign and validate program codes for IRF claims using criteria specific to IRF claims.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 04, 2023
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