Attention: Timeframes for Documentation Responses for Probe Reviews and Targeted Medical Reviews

This article is to notify providers that WPS GHA is defining what is considered a timely submission of documentation for the corrective action determination. Beginning with any post pay probe that is open on or after March 15, 2017, the provider has 45 days to submit documentation for review (unless the provider has contacted GHA Medical Review and requested an extension to provide the requested documentation). After 45 days, barring a provider-requested extension, a decision will be made regarding the appropriate corrective action based on the documentation that has been received. For claims selected for prepay review (Targeted Medical Reviews and Corrective Action Plans), if documentation is not returned in 45 days in response to the individual additional documentation request letter, the claim will auto deny without medical review. Extensions are NOT granted for prepay reviews. WPS GHA will also make a determination of liability for services and whether you are without fault for overpayments

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INDUSTRY NEWS TAGS: WPS Medicare, MAC J5 Iowa, MAC J5 Kansas, MAC J5 Missouri, MAC J5 Nebraska, MAC J8 Indiana, MAC J8 Michigan

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