Coding Reimbursement Medicare Coding Development Private Payers Model Policies Practice Management Resources Medicare Quality Payment Program Accreditation PQI Templates Prior Authorization Issues Form Astro Form Text Type of Comment (indicate if new or recurrent as applicable) Radio buttons - Type of Comment Complaint Specific Problem Suggestion Astro Form Text - Header Please Provide the Following Information (*Required) Full Name ASTRO Member Number Text area Office Address City State Zip Code Text input Office Phone Number Fax Number Email Contact Person Patient’s Health Plan Rad Onc Benefit Manager Astro Form Text- Radiation Oncology Benefit Manager Treatment Modality in question Text - Type of Problem Type of Problem Radio buttons - Treatment Modality in question IMRT Brachytherapy 3-D conformal external beam therapy 2-D photon external beam therapy Electrons Proton Beam SRS SBRT IGRT IORT Other Radio buttons -Type of Problem Delay in preauthorization process Denial of preauthorization Delay in treatment Delay in payment Denial of claim after treatment was authorized Other Astro Form Text - Spacer Problem - Other Astro Form Text - description of your issue Please provide a brief description of your issue/experience with preauthorization procedures Please describe the issue Related CPT Codes Astro Form Text - Have you contacted the ROBM and/or health plan? Have you contacted the ROBM and/or health plan? Radio buttons - contacted the ROBM Yes No Details Further assistance Astro Form Text - Contact Please contact the Health Policy Department with any further questions at 703-502-1550.
