J5 MAC Part A Providers serving beneficiaries in Iowa, Kansas, Missouri and Nebraska

Medical Review


Welcome to the WPS Medicare Medical Review Web page. The Medical Review Department's goal is to reduce the contractor's claims payment error rate by identifying patterns of inappropriate billing through data analysis, performing medical review of claims, and developing local policy to address program vulnerabilities.

Medical Review Address

WPS Medicare Part A
Medical Review
P.O. Box 8310
Omaha, NE 68108-0310

Medical Review Information

Medical Review's goal is to reduce the contractor's claims payment error rate by identifying patterns of inappropriate billing through data analysis, performing medical review of claims, and developing local policy to address program vulnerabilities.

Documentation Guidelines - To access recommendations for the type of information and/or medical records to submit when we request it select from the list of services.

FAQ's - FAQs regarding coverage and medical review related claim and billing considerations.

Bulletin Board - Information on widespread service specific errors identified during medical review and other important postings.

Submitting Medical Records - Instructions for submitting medical records to WPS for post-pay probe reviews, and pre-pay medical review.

WPS Medical Review Process

 

 

Page Last Updated: Friday, 06-Nov-2009 14:04:41 CST