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Assistant Surgeon Review 

Due to a request from Medicaid, our Prior Authorization (PA) number formatting has changed, effective 7/1/10.  All AFMC PA numbers now begin with the letter A.

For medical payment to be made to an assistant surgeon, the physician who wishes to use an assistant surgeon must obtain prior authorization from the Arkansas Foundation for Medical Care  (AFMC). See Section 241.000 of the Arkansas Medicaid Provider Manual for prior authorization instructions. This provision applies to all surgery. (See Section 241.000, page II-69, in the Arkansas Medicaid Provider Manual, regarding Assistant Surgery program coverage)
When calling AFMC to obtain authorization for an assistant surgeon, the following information will be required:

  1. Patient name and address (including zip code)
  2. Patient birth date
  3. Patient Medicaid number
  4. Admission and procedure date
  5. Hospital or ambulatory surgery center name
  6. Facility Medicaid provider number
  7. Medicaid provider number and name of primary surgeon
  8. Office phone number of primary surgeon
  9. CPT code for procedure(s)
  10. Principal diagnosis and any other diagnoses
  11. Signs/symptoms of illness
  12. Medicaid provider number and name of assistant surgeon
  13. A medical explanation of why an assistant surgeon is required — for instance, the complexity of the procedure requires two surgeons to perform the procedure simultaneously

AFMC pre-certification phone number: 800-426-2234
AFMC phone review hours: 8:30 a.m.-12 p.m. and 1 p.m.-5 p.m. Monday through Friday, with the exception of holidays. All calls are monitored for quality assurance purposes.

Questions?

E-mail: Internal Review Manager/AFMC
mump_contact@afmc.org

ATTENTION! e-mail is not secure and PHI must not be sent via e-mail.

Authorization for procedures, assistant surgeons or length of stays indicates that AFMC has determined medical necessity. It does not indicate that the patient is eligible for Medicaid coverage. The provider is responsible for verifying patient eligibility for the dates of service.