Medical review
Targeted probe and educate (TPE) round results: Endovascular cardiac valve replacement and supplement procedure (DRG 266 & 267)
Review the top denial/partial denial reasons and high-level results from each round of DRG 226 and 267 TPE.
Understanding the PAP for certain hospital outpatient department (OPD) services
The following document was developed based on questions and answers posed during our webinars on the prior authorization (PA) program for certain hospital outpatient department (OPD) services.
Understanding the PAP for certain hospital outpatient department (OPD) services
The following document was developed based on questions and answers posed during our webinars on the prior authorization (PA) program for certain hospital outpatient department (OPD) services.
Understanding repetitive scheduled non-emergent ambulance transports
Review these FAQs to learn more about the prior authorization for repetitive scheduled non-emergency ambulance transport.
Prior authorization coversheet instructions
To submit a prior authorization request, complete the prior authorization coversheet. Failure to populate every field could result in delays in processing your request, a non-affirmed decision, or a…
Prior authorization coversheet instructions
To submit a prior authorization request, complete the prior authorization coversheet. Failure to populate every field could result in delays in processing your request, a non-affirmed decision, or a…
Blood product HCPCS codes no longer requiring a paper invoice (JN)
To reduce provider burden, certain contractor priced HCPCS codes no longer require a paper invoice.
Blood product HCPCS codes no longer requiring a paper invoice (JN)
To reduce provider burden, certain contractor priced HCPCS codes no longer require a paper invoice.
Checklist: Pulmonary rehabilitation services
This checklist is being provided as a tool to assist providers when responding to medical record documentation requests for pulmonary rehabilitation services.