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 the request for a contact person and their information.   

Providing a contact person and their contact information as requested is extremely important. Without having the correct contact person, any intraprobe or follow up calls cannot be made. The medical review nurses, if deemed necessary, will make intraprobe calls to request missing documentation, to ask questions about the submitted documentation and to inquire about the care provided to assist them with making the appropriate decisions on your claims. Therefore, it is imperative you supply us with a contact person and the correct contact information.