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This edition includes information on hospital price transparency, providers accepting CHAMPVA, a Medicare fraud alert, and more.
Review the top denial / partial denial reasons and high-level results listed below from each round of JN ESRD TPE reviews.
View targeted probe and educate (TPE) round results for end stage renal disease (ESRD).
DHHS authorizes an extension of Medicare fee-for-service (FFS) response to hurricane Helene for the state of Georgia.
View this updated listing of targeted probe and educate (TPE) review topics.
Review the top denial / partial denial reasons and high-level results of evaluation and management services – emergency department visits TPE round results.
View this information on MFA and instructions to register MFA devices.
Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process allows the provider to submit documentation prior to providing or billing the service. The contractor will then al…
View contact information for the Claims area.
Surgeons append modifier 66 to claims indicating they were on a team of surgeons performing a specific procedure on the same patient during the same operative session. Billing modifier 66 requires documentation to support the claim.