Targeted probe and educate (TPE) round results: Skilled nursing facility (SNF)
Review the top denial / partial denial reasons and high-level results of SNF TPE round results.
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Targeted probe and educate (TPE) round results: Diagnostic-related group (DRG) 885 - psychosis
Review the top denial / partial denial reasons and high-level results listed for DRG 885.
Prior authorization of ambulance claims requires UTN in proper field
Repetitive, scheduled non-emergent ambulance transport (RSNAT) has been effective as of April 1, 2022. Through this program, a...
YouTube video: Answers to your prior authorization exemption questions
Are you participating in prior authorization and want to know how to maintain exemption within this program? Do you have...
Prior authorization for hospital outpatient department services: Don’t wait too long to submit your prior authorization requests
When submitting prior authorization requests, be aware of response timeframes and documentation guidelines.
Prior authorization for ambulance transports is for repetitive transports
A repetitive service is defined as medically necessary ambulance transportation that is furnished three or more times during a...
Prior authorization: Facet joints and cervical fusion
CMS has removed CPT codes 64492 and 64495 from the listing of codes requiring prior authorization. View our article to learn...
Facet joint interventions for pain management
Facet joint interventions may be used in pain management for chronic cervical/thoracic and lumbar/sacral pain arising from the...
Checklist: Chronic care
This checklist is intended to provide health care providers with a reference for use when responding to medical documentation...
Checklist: Clinical labs
This checklist is intended to provide health care providers with a reference for use when responding to medical documentation...