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Payor Information
Medicare
- Medicare website
- Medicare Payment Information
- Medicare Contractor/Carrier Information and AUA National Insurer Advisory (NIA) Workgroup [login required]
- Least Costly Alternative Policy Changes
- National Provider Identifier Application
- MIPS
- Medicare Accreditation Program [pdf]
Common Urology Drug Payment
- What is the Average Sales Price (ASP) for Drugs and How does CMS Calculate the ASP Based Payment Limit? [pdf]
- Quarterly ASP Drug Payments Chart [pdf]
Appeals
- Understanding the Medicare Appeal Process: Getting Your Claims Paid
- Chart of Medicare Appeals Process [pdf]
- Appeal Letters
National Correct Coding/Medically Unlikely Edits Initiatives
- How to Use THE NATIONAL CORRECT CODING INITIATIVE (NCCI) TOOLS [pdf]
- National Correct Coding Initiatives Edits
- Medically Unlikely Edits
- Physician Fee Schedule
- Medicare Coverage Database (National and Local Coverage Determination by state)
- Medicare Appeals Process
- Appeals Process Diagram [pdf]
- Form CMS-20031 Transfer assignment [pdf]
Information on Reopenings
- Claims Processing Manual, Pub. 100-04 [pdf]
- Form CMS-20027 Redetermination [pdf]
- Form CMS-20033 Reconsideration [pdf]
- Reopening Medlearn Article [pdf]
- Request for Administrative Law Judge Review [pdf]
- Request for Appeals Council Review [pdf]
Private Insurers (Commercial)
Appeals
- Understanding Private Insurers Appeals Process: Getting Your Claims Paid [pdf]
- UnitedHealthcare Appeals document [pdf]
- Appeal Letters
Aetna Dual Certification/Accreditation for In-office Surgical Pathology Laboratories Letter
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