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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…
View targeted probe and educate (TPE) round results for 15271-15278.
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.
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.
Learn how PWK, the paperwork segment of the X12N version 5010, allows providers to submit medical documentation with their initial claim.
Read this article for information about how CERT may grant temporary administrative relief to certain affected providers and suppliers during a disaster.
Nasal surgery is any procedure performed on the external or internal structures of the nose, septum or turbinate.