Medical Review Frequently Asked Questions (FAQs)

Q1: Is Targeted Probe and Education resuming?
A1: Target Probe and Educate (TPE) will be resuming. If your facility is chosen for review, you will receive a notification letter via mail indicating the service and reason for review. For more information on TPE refer to Targeted Probe and Educate (TPE)

Q2: How will we know what claims are chosen for TPE review?
A2: When claims are billed and pulled for TPE review, providers will receive an Additional Documentation Request (ADR). For information on the different ways to check for an ADR refer to How Do I Check DDE for an ADR?

Q3: What happens to files for TPE review that were suspended during COVID? Will they resume where they were or be re-initiated?
A3: TPE reviews will start with round 1. Providers who had TPE reviews suspended due to the Public Health Emergency (PHE) have been sent letters regarding the status of those reviews.

 

Last Updated Fri, 10 Sep 2021 15:16:18 +0000