eTAR Processing Guidelines
Medi-Cal providers are encouraged to use the following practical tips for submitting 50-1 inpatient/outpatient and hospital electronic Treatment Authorization Requests (eTARs). These tips offer valuable information that makes it easier for providers to successfully submit eTARs and expedite the process. Although inpatient providers may not submit a Request for Extension of Stay in Hospital (18-1) form online, they can submit any procedures online normally submitted using the TAR (50-1) form.
Note: Providers who participate in the eTAR program are advised to bookmark this page for future reference.
When submitting attachments, include all the pertinent documentation that medically justifies why the service is needed. The following are some examples:
- Verify that valid reasons for admission are documented.
- Submit radiological reports and lab data to support admission.
- For retroactive eTARs, submit operative notes, pathology reports and discharge summary from the hospital.
- For non-formulary drugs, submit scheduling of treatment and any reasons for changing doses.
- For MRI procedures, submit the lab, X-ray and CT scan reports.
The Miscellaneous TAR Information field of an eTAR allows providers to enter information that medically justifies the need for the TAR. Providers may enter up to 500 characters in this field.
- For retroactive eTARs, providers should make sure the requested From Date and Thru Date fields are entered correctly.
- Non-formulary drugs need to have the unit dosages clarified for each treatment. Also, total units need the scheduling date of the planned treatment.
- Providers should include a brief, detailed medical justification description.
- Retroactive to November 1, 2008, providers must use a Medi-Cal registered National Provider Identifier (NPI) on all TARs. If providers use legacy numbers, the TARs may be denied.
- Providers should verify that all information is accurate prior to submitting the TAR, including the patient’s name, Medi-Cal ID and the provider NPI.
- When submitting an eTAR for hospital days and a procedure, providers should make sure that the hospital day service is entered on the first line of the TAR and the procedure (whether it requires a TAR or not) is entered on the second service line.
- Providers should not submit both, an eTAR and paper TAR for the same service. They should choose only one method to submit a request to ensure that there is no duplication.
- If a TAR is split-billed between two providers, the Rendering Provider Number field must be completed with the correct NPI.
- Providers should make sure modifiers are used correctly with the appropriate CPT-4 codes.
Providers should refer to the Modifiers: Approved List manual section for further information. Effective August 1st 2010, modifier ZS (Professional & Technical Component) will no longer be reimbursable. Please review the Modifier ZS No Longer Reimbursable with MRA, MRI and PET Scans article.
- Use the eTAR application on the Transaction Services page of the Medi-Cal Web site. For self-paced training online, providers can review the eTAR tutorials on the eLearning page of the Medi-Cal Web site by clicking the eLearning link.
- To inquire about the status of a TAR, call 1-800-541-5555. Please do not call the field office.
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