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This checklist is intended to provide health care providers with a reference for use when responding to medical documentation requests for Drugs and Biologicals.
This article is designed to assist medical providers with documenting the beneficiary’s medical condition supporting coverage for non-emergent ambulance transportation.
Claims submitted for a prior authorization request (PAR) that received a provisional affirmation PA decision, including any service that was part of a partially affirmed decision, must include the 14-byte unique tracking number (UTN) number…
CMS is implementing a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020. Review the fax coversheet needed for submission.
CMS has removed CPT codes 64492 and 64495 from the listing of codes requiring prior authorization. View our article to learn more about these changes.
Background
Submissions
Extended affirmation periods
View targeted probe and educate (TPE) round results for clinical laboratory services: culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed CPT 87150.
Review the top denial / partial denial reasons and high-level results listed for DRG 885.
This checklist is being provided as a tool to assist providers when responding to medical record documentation requests for cardiac rehabilitation services.
This checklist is being provided as a tool to assist providers when responding to medical record documentation requests for pulmonary rehabilitation services.