Notification Letters

Notification Letters Prior to the start of the TPE, providers are being placed on medical review will receive a notification letter. The notification will have the edit name, the reason for review, instructions for sending in the ADR and [...]

LVAM Request Form

Counting 90-Day Election Periods - Leap Year

Who May File an Appeal?

Who May File an Appeal?Any of the following persons or entities is considered a party to an appeal of a claim for items or services payable under Medicare and, therefore, may appeal the initial claim determination and any subsequent appeal [...]

What Documents are Needed

What Documents are NeededYou are required to submit all necessary medical documentation to support the services billed on your claim as part of your participation agreement; you must submit a complete medical record when requesting an appeal. [...]

Comprehensive Error Rate Testing Program

Medicare Diabetes Prevention Program (MDPP)

This section gives you access/education about first time Enrollment.

Supplemental Right Side Content Part A

Helpful ResourcesTPE Manual

How to Respond to Additional Development Requests for Herceptin Billing

How to Respond to Additional Development Requests for Herceptin BillingSeveral providers are responding to Herceptin-related ADRs without providing the required information. Herceptin billing must contain the number of milligrams that were used [...]