NGS Delays TPE Medical Reviews
April 9, 2020
Today, National Government Services (NGS) announced it is pausing Targeted Probe and Educate (TPE) Medical Reviews. NGS did not provide additional clarity on when or how TPE reviews will resume. NGS is contacting providers to let them know claims have been released and there is no need to respond to an additional development request for medical records.
Effective March 1, 2020, claims that were auto-denied for nonresponse or late response to additional development requests will be reversed and allowed for payment unless an appeal has already been filed. If an appeal has already been filed, it will follow the normal appeals process. Questions can be directed to email@example.com for jurisdiction Part A questions, and J6Bprobeandeducate@anthem.com for jurisdiction 6 Part B questions.