Immunosuppressive Drugs Targeted Probe and Educate Review Updates: July - September 2018

The Jurisdiction D, 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 July - September 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 39%.

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 date of service for item(s) billed has been paid
  • Detailed Written Order (DWO) is incomplete or missing elements

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


            Last Updated Mon, 31 Dec 2018 10:49:25 +0000