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Effective for dates of service July 1, 2021, and after, hospital outpatient department (HOPD) providers will need to obtain prior authorization (PA) for cervical fusion with disc removal if performed in a HOPD setting and billed with the fo…
View TPE round results for wound debridement (CPT 11102-11103, 11200-11201, 11300-11303, 11305-11313 and 11401-11406, 11421-11424, 11426, 11440-11446).
View TPE round results for psychotherapy services.
View targeted probe and educate (TPE) round results for end stage renal disease (ESRD).
Review the top denial/partial denial reasons and high-level results of wound debridement (CPT 11042-11045) TPE round results for December 2022 - May 2023.
View these submission guidelines for ASC prior authorization requests.
First Coast has compiled a list of questions on specific topics that are listed in the CMS IRF RCD Medical Records Review Checklist as well as the Code of Federal Regulations that providers can use as a resource to determine if their docume…
Prior authorization (PA) for the ASC prior authorization demonstration is voluntary. However, if a provider elects to bypass PA, applicable ASC claims will be subject to prepayment medical review.
The PAR fax/mail coversheet for ASCs is now available for Florida ASCs participating in the ASC PA demonstration. ASCs in Florida can submit PARs beginning on January 5, 2026, for dates of service (DOS) on or after January 19, 2026.
Due to a claim issue identified, exempt hospital OPDs will be receiving a revised exemption ADR letter with a revised letter fax cover sheet.