Medical review

Learn how PWK, the paperwork segment of the X12N version 5010, allows providers to submit medical documentation with their initial claim.

Learn how to complete the the prior authorization request (PAR) coversheet for repetitive scheduled non-emergency ambulance transports.

This checklist is intended to provide health care providers with a reference to use when responding to medical documentation requests for DRG validation services.

Repetitive, scheduled non-emergent ambulance transport (RSNAT) has been effective as of April 1, 2022. Through this program, a unique tracking number (UTN) is issued for each medical decision…

View targeted probe and educate (TPE) results - drugs and biologicals (HCPCS J0897).

View targeted probe and educate (TPE) results - drugs and biologicals (HCPCS J0897).

Follow this instructions to learn how to file a claim once you received the unique tracking number (UTN) related to the prior authorization of repetitive, scheduled non-emergency ambulance transports…

The PA team has been receiving and processing prior authorization requests (PAR) for certain hospital OPD services. View the following reminders prior to submitting your request.

Review the top denial / partial denial reasons and high-level results listed for DRG 885.

View targeted probe and educate (TPE) round results for clinical laboratory services: culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or…