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Find information and resources that will help you properly respond to additional documentation requests within required timeframes.
View targeted probe and educate (TPE) round one results for surgical services: endovascular revascularization (open or percutaneous, transcatheter) procedures CPT 37229 from October 2021 - April 2022.
View targeted probe and educate (TPE) round one results for rehabilitation services.
View targeted probe and educate (TPE) for surgical services - cataract extraction (CPT 66982-66984).
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.
Due to a claim issue identified, exempt hospital OPDs will be receiving a revised exemption ADR letter with a revised letter fax cover sheet.
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.