Targeted probe and educate (TPE) round results: Rehabilitation services outpatient (KX modifier)
View TPE round results for rehabilitation services outpatient (KX modifier).
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Targeted probe and educate round results: Transitional care management
Top denial/ partial denial reasons and high-level results are listed below from each round of Transitional Care Management (TCM)...
Targeted probe and educate (TPE) round results: End stage renal disease (ESRD) (CPT 90999)
Review the top denial / partial denial reasons and high-level results listed below from each round of JN ESRD TPE reviews.
Advance payment – Part B only
View this article for information about Part B advance payment submissions.
Ambulance physician certification statement
Physician certification statements (PCS) are required for patients who are under the direct care of a physician and are required...
Prior authorization program initiatives
Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process...
Paperwork (PWK)
Learn how PWK, the paperwork segment of the X12N version 5010, allows providers to submit medical documentation with their...
Prior authorization (PA) program for certain hospital outpatient department (OPD) services - submitting the prior authorization request (PAR)
View these submission guidelines when submitting prior authorization requests for certain hospital outpatient department...
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.