Medical review
Attention exempt hospital outpatient departments (OPDs): Revised additional documentation request (ADR) letters
Due to a claim issue identified, exempt hospital OPDs will be receiving a revised exemption ADR letter with a revised letter fax cover sheet.
Attention exempt hospital outpatient departments (OPDs): Revised additional documentation request (ADR) letters
Due to a claim issue identified, exempt hospital OPDs will be receiving a revised exemption ADR letter with a revised letter fax cover sheet.
Documentation requirements to support medical necessity for Inpatient Rehabilitation Facility (IRF) stay
First Coast has compiled a list of questions on specific topics that are listed in the CMS IRF RCD Medical Records Review Checklist as well as the Code of Federal Regulations that providers can use…
Documentation requirements to support medical necessity for Inpatient Rehabilitation Facility (IRF) stay
First Coast has compiled a list of questions on specific topics that are listed in the CMS IRF RCD Medical Records Review Checklist as well as the Code of Federal Regulations that providers can use…
Provider documentation tool for non-emergent ambulance transportation
This article is designed to assist medical providers with documenting the beneficiary’s medical condition supporting coverage for non-emergent ambulance transportation.
Ambulatory surgical center (ASC) prior authorization request (PAR) submission guidelines
View these submission guidelines for ASC prior authorization requests.
Ambulatory surgical center (ASC) prior authorization (PA) claim submission guidelines
Prior authorization (PA) for the ASC prior authorization demonstration is voluntary. However, if a provider elects to bypass PA, applicable ASC claims will be subject to prepayment medical review.
Prior authorization request (PAR) ambulatory surgical center (ASC) procedures Medicare Part B fax/mail coversheet
The PAR fax/mail coversheet for ASCs is now available for Florida ASCs participating in the ASC PA demonstration. ASCs in Florida can submit PARs beginning on January 5, 2026, for dates of service (…
Targeted probe and educate (TPE) round results: Surgical services - nail cutting / pairing and debridement (CPT 11055-11057, 11719-11721 & HCPC G0127)
View targeted probe and educate (TPE) round results for nail cutting / pairing and debridement (CPT 11055-11057, 11719-11721 & HCPC G0127).
Targeted probe and educate (TPE) round results: Surgical services - nail cutting / pairing and debridement (CPT 11055-11057, 11719-11721 & HCPC G0127)
View targeted probe and educate (TPE) round results for nail cutting / pairing and debridement (CPT 11055-11057, 11719-11721 & HCPC G0127).