Medical review
Targeted probe and educate (TPE) round results: Rehabilitation services outpatient (KX modifier)
View TPE round results for rehabilitation services outpatient (KX modifier).
Targeted probe and educate (TPE) round results: Rehabilitation services outpatient (KX modifier)
View TPE round results for rehabilitation services outpatient (KX modifier).
Targeted probe and educate (TPE) round results: Rehabilitation services outpatient
View these round results for rehabilitation services outpatient.
Targeted probe and educate (TPE) round results: Rehabilitation services outpatient
View these round results for rehabilitation services outpatient.
Targeted probe and educate round results: Transitional care management
Top denial/ partial denial reasons and high-level results are listed below from each round of Transitional Care Management (TCM) services TPE reviews that have been conducted thus far by Medical…
Ambulance physician certification statement
Physician certification statements (PCS) are required for patients who are under the direct care of a physician and are required to verify the medical necessity for certain scheduled and unscheduled…
Paperwork (PWK)
Learn how PWK, the paperwork segment of the X12N version 5010, allows providers to submit medical documentation with their initial claim.
Paperwork (PWK)
Learn how PWK, the paperwork segment of the X12N version 5010, allows providers to submit medical documentation with their initial claim.
Prior authorization (PA) program for certain hospital outpatient department (OPD) services - submitting the prior authorization request (PAR)
View these submission guidelines when submitting prior authorization requests for certain hospital outpatient department services.
Tools & forms: Compliance / Review
Access tools and forms related to the prior authorization program, CERT, and provider audit.