Immunosuppressive Drugs Targeted Probe and Educate Review Updates: October-December 2018
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 October 2018 through December 2018 are as follows:
Based on dollars, the overall claim potential improper payment rate is 28%.
Top Denial Reasons
- Documentation was not received in response to the Additional Documentation Request (ADR) letter.
- Refill request documentation is incomplete or missing elements.
- The detailed written order is expired per number of refills.
- Documentation does not support coverage criteria.
For complete detail see, Immunosuppressive Drugs Quarterly Results of Targeted Probe and Educate Review
Last Updated Mar 06, 2019