ADR (Additional documentation requests)
Find information and resources that will help you properly respond to additional documentation requests within required...
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Targeted probe and educate (TPE) round results: End stage renal disease (ESRD) (CPT 90960)
View targeted probe and educate (TPE) round results for end stage renal disease (ESRD).
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.
Skilled nursing facility (SNF) 5-claim probe and educate (P&E) round results
View this article to view the results for the SNF 5-claim probe and educate (P&E).
Prior authorization program initiatives
Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process...
Targeted probe and educate (TPE) round results: Major hip and knee replacement (DRG 470)
Review the top denial / partial denial reasons and high-level results from each round of DRG 470 TPE.
Targeted probe and educate (TPE) round results: Evaluation and management services – emergency department visits
Review the top denial / partial denial reasons and high-level results of evaluation and management services – emergency...
Claims with CPT code 90658, influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use, pricing incorrectly
Payment issue affecting CPT code 90658, influenza virus vaccine.
Payment issue affecting end stage renal dialysis services on type of bill 72X
Payment issue affecting end stage renal dialysis services on type of bill 72X.
Targeted probe and educate (TPE) topics and schedule of review
View this updated listing of targeted probe and educate (TPE) review topics.