Prior authorization program
Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process...
Multifactor authentication and SPOT registration
Information on MFA and instructions to register MFA devices.
Targeted probe and educate (TPE) round results: Major hip and knee replacement (DRG 470)
Review the top denial / partial denial reasons and high-level results from each round of DRG 470 TPE.
Targeted probe and educate (TPE) round results: Evaluation and management services – emergency department visits
Review the top denial / partial denial reasons and high-level results of evaluation and management services – emergency...
Claims adjusted in error due to an issue that affected some professional claims for the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model
CMS is aware of an issue that occurred on July 26 that affected some 2021-2024 professional claims for the Accountable Care...
Claims with CPT code 90658, influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use, pricing incorrectly
Payment issue affecting CPT code 90658, influenza virus vaccine.
Claims with CPT codes 90653, 90656, 90657, 90660, 90661, 90662, 90658, and 90673 priced incorrectly
2024-2025 flu season codes priced incorrectly.
Payment issue affecting end stage renal dialysis services on type of bill 72X
Payment issue affecting end stage renal dialysis services on type of bill 72X.
Targeted probe and educate (TPE) topics and schedule of review
View this updated listing of targeted probe and educate (TPE) review topics.