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Hospital outpatient departments that qualify for an exempt status effective January 1, need to have at least 10 claims submitted and finalized.
Review the top denial / partial denial reasons and high-level results listed below from each round of JN ESRD TPE reviews.
Top denial/ partial denial reasons and high-level results are listed below from each round of Transitional Care Management (TCM) services TPE reviews that have been conducted thus far by Medical Review.
View TPE round results for rehabilitation services outpatient (KX modifier).
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…