Targeted Probe and Educate

Best Practices for a Successful Targeted Probe and Educate Review

Table of Contents

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Getting Started With TPE:

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Notification Letter:

  • Respond to the notification letter with a point of contact so the Medical Review team may reach out with questions and to resolve easily curable errors through intra probe education.
    • Sharing a phone number and email will increase the likelihood of a successful intra probe call, when needed, as well as expedite post probe education scheduling.
  • Best practice suggestion: Initiate internal dialogue with your patient care team, compliance, billing, etc. to ensure all pertinent departments are involved and aware of the review.

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During the Review Process:

  • Ask questions during the review process, don't wait for the post-probe education!
  • Reach out early if you are seeing denied claims and you are unaware of the reason, for example: a treatment plan is noted as missing and you believe you sent one in for review, so you may remedy this before all claims have been requested, reviewed and processed.

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Post-Probe/Review Results Letter:

  • We encourage you to reach out within seven days of receipt of the Results Letter to schedule education. Use the appropriate CMT address above if you have not received your letter, as we are able to ensure you receive this letter and schedule education accordingly.
    • This will ensure you receive education catered to your needs, and adequate time to identify areas for improvement and implement appropriate process changes.
  • If you decline education, or do not reach out to schedule education, you will be moved to the next round of review, which may start 45 days from the date on your Results Letter.

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Prepare for Post-Probe Education:

  • Monitor your appeal deadline—Do not wait for education to submit your appeals. If you disagree with a decision, or have additional supporting documentation for a denied claim, please ensure you are submitting an appeal timely. Do not wait for the Results letter to submit an appeal.
    • Click here to learn About Appeals.
    • Ensure appropriate staff are available for the educational call.
    • Share the Results Letter and corresponding spreadsheet with appropriate staff to ensure the team is prepared for the call and can receive answers to their questions.
    • Review your complete denial rationales so you know the specifics related to the denied claims.
    • Read the entire reason statement/rationale for your denied claims to appropriately address all denied elements upon appeal if you choose to proceed with an appeal.
    • If you experience challenges, please reach out to the CMT email addresses listed above. We can help you!

Reviewed 6/18/2024

Helpful Resources

Targeted Probe and Educate Manual

Helpful Resources

Targeted Probe and Educate Manual

NGSConnex
Log Into NGSConnex
NGSConnex User Guide

USPS
National Government Services, Inc.
P.O. Box 7108
Indianapolis, IN 46207-7108

UPS/FedEx
National Government Services, Inc.
220 Virginia Ave
Indianapolis, IN 46204
ATTN: Mail & Distribution
*Add/insert the operational unit record to be scanned

Direct Fax
315-442-4390

Helpful Resources

Targeted Probe and Educate Manual

NGSConnex
Log Into NGSConnex
NGSConnex User Guide

USPS
National Government Services, Inc.
P.O. Box 7108
Indianapolis, IN 46207-7108

UPS/FedEx
National Government Services, Inc.
220 Virginia Ave
Indianapolis, IN 46204
ATTN: Mail & Distribution
*Add/insert the operational unit record to be scanned

Direct Fax
315-442-4390

Helpful Resources

Targeted Probe and Educate Manual

NGSConnex
Log Into NGSConnex
NGSConnex User Guide

USPS
National Government Services, Inc.
P.O. Box 7108
Indianapolis, IN 46207-7108

UPS/FedEx
National Government Services, Inc.
220 Virginia Ave
Indianapolis, IN 46204
ATTN: Mail & Distribution
*Add/insert the operational unit record to be scanned

Direct Fax
315-442-4231

Helpful Resources

Targeted Probe and Educate Manual

NGSConnex
Log Into NGSConnex
NGSConnex User Guide

USPS
National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475

UPS/FedEx
National Government Services, Inc.
220 Virginia Ave
Indianapolis, IN 46204
ATTN: Mail & Distribution
*Add/insert the operational unit record to be scanned

Direct Fax
317-595-4364

Helpful Resources

Targeted Probe and Educate Manual

NGSConnex
Log Into NGSConnex
NGSConnex User Guide

USPS
National Government Services, Inc.
P.O. Box 7108
Indianapolis, IN 46207-7108

UPS/FedEx
National Government Services, Inc.
220 Virginia Ave
Indianapolis, IN 46204
ATTN: Mail & Distribution
*Add/insert the operational unit record to be scanned

Direct Fax
315-442-4154

Helpful Resources

Targeted Probe and Educate Manual

NGSConnex
Log Into NGSConnex
NGSConnex User Guide

USPS
National Government Services, Inc.
P.O. Box 6474
Indianapolis, IN 46206-6474

UPS/FedEx
National Government Services, Inc.
220 Virginia Ave
Indianapolis, IN 46204
ATTN: Mail & Distribution
*Add/insert the operational unit record to be scanned

Direct Fax
315-442-4154