Immunosuppressive Drugs Targeted Probe and Educate Review Updates: April-June 2019

The Jurisdiction A, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) J7507, J7517, J7518, and J7520. The quarterly edit effectiveness results from April 2019 - June 2019 are as follows:

Based on dollars, the overall claim potential improper payment rate is 17%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter
  • Documentation does not support coverage criteria
  • The detailed written order is expired per number of refills
  • Documentation does not include a DWO

For complete detail see, Immunosuppressive Drugs Quarterly Results of Targeted Probe and Educate Review

            Last Updated Tue, 22 Oct 2019 12:50:12 +0000