Top denial/partial denial reasons and high-level results are listed below from each round of JH and JL TPE reviews that have been conducted thus far by us. If you have questions about your individual results, please contact the nurse reviewer assigned to your review for additional information. Additional rounds of review will be utilized when the targeted topic demonstrates a continued need for review with newly identified providers.
The most common reasons for denial or partial denials are the following:
Medical necessity
The documentation submitted does not support medical necessity as listed in coverage requirements.
Insufficient documentation
Insufficient documentation was provided to support the services as billed to Medicare. We make multiple attempts to correct these error types before completion of the review.
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