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OnBoard Training: Payers Changing PAR Response

Training: Payers

Changing a Grant-in-Part or Denial to a Grant

After the Level 1 or Level 2 reviewer submits a grant-in-part or denial for any PAR type except Medication, the reviewer can change the response from a grant-in-part or denial to a grant. Changing the response can only be done for administrative, jurisdiction, or IME related denials. This can be done by the Level 1 reviewer until the Level 2 reviewer has submitted a response. It can be done by a Level 2 reviewer until the time that the Level 3 (Board’s Medical Director’s Office) issues a Notice of Resolution.

A medical denial will not allow a response to be changed.

To change the PAR response, go to Submitted eForms.

Submitted eForms

Select the PAR ID link in the eForm Details column.

PAR Details Page

On the PAR Details page, select the Actions button on the top right and select Change Response.

Change Response Button

Select Grant in the Insurer Response dropdown and answer the additional questions.

PAR Response

Answer the claim apportioned question(s).

Claim Apportionment NO

Upload any new supporting documentation that supports the change in the response.

Document Upload Button

Review the details included in the new response. Select Submit.

PAR Response Details

The confirmation will show that the grant after denial or grant in part has been successfully submitted.

Grant Confirmation

In the Submitted eForms tab, the PAR response will be updated under eForm Name with Grant After Denial or Grant after Grant in Part as appropriate.

Submitted eForms