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This checklist is intended to provide health care providers with a reference for use when responding to additional documentation requests for transitional care management (TCM) services.
Review the top denial / partial denial reasons and high-level results of evaluation and management services - initial inpatient care visits and subsequent inpatient care visits TPE round results.
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.
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…
Access tools and forms related to the prior authorization program, CERT, and provider audit.
Use these checklists to ensure you have met medical documentation requirements based on specific services.
View targeted probe and educate (TPE) round results for ambulance services: basic life support non-emergent transport and mileage (HCPCS A0428 and A0425).