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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).
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.
Find information on vaccine payment allowances and fee schedules, links to related enrollment for mass immunizers, and more. Recent additions include upcoming vaccine administration coding updates beginning July 1, 2026, for TOFIDENCE® IV i…