Postpayment Service-Specific Probe Results for Bevacizumab 10mg for January through March 2021
Palmetto GBA performed service-specific post payment probe review on HCPCS Code J9035 — Bevacizumab, 10 mg. This edit was set in Alabama, Georgia and Tennessee. The results for the service-specific edit in Georgia and Tennessee will be presented in a future article. The results for the first quarter probe review, for claims processed January through March 2021 are presented here.
Cumulative Results
A total of 39 claims were reviewed, with none of the claims completely or partially denied, resulting in an overall claim denial rate of 0.0 percent. The total dollars reviewed was $209,620.27, of which $0.00 was denied, resulting in a charge denial rate of 0.0 percent. Overall, there was one auto-denied claim in the region.
Alabama Results
A total of 39 claims were reviewed, with none of the claims completely or partially denied. This resulted in a claim denial rate of 0.0 percent. The total dollars reviewed was $209,620.27, of which $0.00 was denied, resulting in a charge denial rate of 0.0 percent. There were no claim denials, therefore no top denial reasons identified.
The Next Steps
The service-specific postpayment medical review edits for HCPCS Code J9035 — Bevacizumab 10 mg in Alabama, Georgia and Tennessee will be continued based on moderate charge denial rates and/or medium to high impact severity errors. If significant billing aberrancies are identified, provider-specific review may be initiated.
If you are dissatisfied with a claim determination you have the right to request an appeal. Palmetto GBA encourages you to review the documentation originally submitted, and if you believe you have additional supporting documentation you may include this information with your appeal. For more information related to the appeals process please refer to the Redetermination: 1st Level Appeal Form (PDF, 236 KB). Questions regarding this medical review can be directed to the Palmetto GBA Provider Contact Center at 877–567–7271.