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This checklist is an aid to assist providers with responding to medical record documentation requests.
View targeted probe and educate (TPE) results - drugs and biologicals (HCPCS J0897).
Are you using regular mail for submissions to First Coast? We have several electronic options that are easier and faster for you to use. Additionally, submitting documentation electronically:
Learn how to complete the the prior authorization request (PAR) coversheet for repetitive scheduled non-emergency ambulance transports.
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.
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).