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The following document was developed based on questions and answers posed during our webinars on the prior authorization (PA) program for certain hospital outpatient department (OPD) services.
Summary for ambulance services (October 2020).
View targeted probe and educate (TPE) round results for ambulance services: basic life support non-emergent transport and mileage (HCPCS A0428 and A0425).
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 non-emergency ambulance transports. Read…
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Are you sending hardcopy mail to submit your requests to First Coast? Did you know there are faster and easier ways to send your requests to us? Avoid the wait. Learn about the electronic options available for you to submit medical review d…
Learn how PWK, the paperwork segment of the X12N version 5010, allows providers to submit medical documentation with their initial claim.
Learn about various programs which focus on ensuring Medicare compliance. Topics include: Comprehensive error rate testing (CERT), prior authorization, and targeted probe and educate.
View targeted probe and educate (TPE) round results for wound care (CPT 11042 and 11045).
Medicare home health referrals must contain information in the medical record from the certifying physician and/or acute/post-acute care facility justifying the referral. Use this checklist to gain an understanding of the criteria necessary…