Checklist: Surgical services - nail cutting/paring and debridement
This checklist is intended to provide health care providers with a reference for use when responding to medical documentation...
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Quick reference chart for billing Medicare secondary payer (MSP) claims
Use this article as a quick reference for billing claims where Medicare is the secondary payer.
Post-payment service-specific reviews
Medical review of claims helps to ensure that Medicare pays for services that are covered, correctly coded, and medically...
Medicare secondary payer (MSP): Medicare as the tertiary payer
Read this article for billing guidelines when Medicare is the tertiary payer.
Medicare secondary payer (MSP) Contractor (formerly Benefits Coordination and Recovery Center [BCRC])
Read this article for more information on contacting the MSP Contractor.
Prior authorization tips and reminders
The PA team has been receiving and processing prior authorization requests (PAR) for certain hospital OPD services. View the...
Skilled nursing facility (SNF) 5-claim probe and educate (P&E) round results
View this article to view the results for the SNF 5-claim probe and educate (P&E).
Prior authorization coversheet instructions
To submit a prior authorization request, complete the prior authorization coversheet. Failure to populate every field could...
Prior authorization (PA) for hospital outpatient department (OPD) services: tips and reminders
The following are tips and reminders that will assist providers in avoiding a delay or dismissal of a prior authorization...
Targeted probe and educate (TPE) round results: Evaluation and management services – emergency department visits
Review the top denial / partial denial reasons and high-level results of evaluation and management services – emergency...