Prior authorization program for certain hospital outpatient department services - claim submission guidelines
Claims submitted for a prior authorization request (PAR) that received a provisional affirmation PA decision, including any...
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Targeted probe and educate (TPE) round results: Major hip and knee replacement (DRG 470)
Review the top denial / partial denial reasons and high-level results from each round of DRG 470 TPE.
Understanding the credit balance report
Review the following questions and answers to gain an understanding of credit balance reporting.
ADR (Additional documentation requests)
Find information and resources that will help you properly respond to additional documentation requests within required...
Implantation of Spinal Neurostimulator
CMS covers the implantation of central nervous system stimulators as a therapy for the relief of chronic intractable pain.
Hospital outpatient department (OPD) prior authorization exemption process
Hospital outpatient departments (OPDs) who demonstrate compliance with Medicare coverage, coding, and payment rules related to...
Repetitive scheduled non-emergency ambulance transport prior authorization claims submission guidelines
Follow this instructions to learn how to file a claim once you received the unique tracking number (UTN) related to the prior...
Medicare secondary payer (MSP) billing
Read this article for more information on how to bill claims when Medicare is the secondary payer.
Change of practice address for individual Part B providers using the Medicare Enrollment Application - Physicians and Non-Physician Practitioners (CMS-855I)
Read this document to learn how to change your address using the 855I enrollment application.
Completing the Medicare CMS-855A enrollment application
View these instructions for completing the CMS-855A form.