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