Prior Authorization and Denial Management

Provides coding guidance for Medicare fee-for-service physician claims.

Provides Medicare coverage summary for mitral TEER procedure.

Provides coding guidance for Medicare fee-for-service echocardiographer claims.

Provides guidance to help facilitate a clinical determination of an individual patient's surgical risk status.

This is a template for use with private insurance companies denying the TEER procedure.

This document provides prior authorization guidance for Mitral TEER procedure claims.

Provides a prior authorization checklist for TriClip TEER claims.

Provides additional guidance and resources for prior authorization and appeal for TriClip TEER procedures.

This is a customizable template letter for use with Medicare Advantage and private insurance companies while seeking prior authorization.  

This is a customizable template letter for use with Medicare Advantage and private insurance companies when prior authorization is denied.  

Provides a coding checklist for inpatient hospital TriClip TEER claims.

Provides a coding checklist for TriClip TEER echocardiographers.

Provides coding guidance for TriClip TEER implanting physicians.

Provides coding guidance for Medicare fee-for-service hospital claims.

Provides coding guidance for Medicare fee-for-service physician claims.

This is a guide for submitting prior authorization requests for your patients. It includes instructions on how to use this tool kit and the associated forms.

This is a sample letter template that provides suggestions for writing a Letter of Appeal of a denial of coverage for LAAC device implant procedures. Physicians should customize the letter based on the patient's actual medical history, diagnosis, and any specific appeal requirements.

This is a sample letter template that provides suggestions for writing a Letter of Medical Necessity or prior authorization request for LAAC device implant. Physicians should customize the letter based on the patient's actual medical history, diagnosis, and any specific prior authorization requirements.

This checklist provides a summary of the information used to process Prior Authorization Requests for Left Atrial Appendage Closure (LAAC) Intervention procedures.

This checklist is for submitting prior authorization requests for your patient. The checklist includes a list of assessments recommended in the latest professional society guidelines for diagnosing a cryptogenic ischemic stroke.

This is a sample letter template that provides suggestions for writing a Letter of Medical Necessity or prior authorization request for PFO closure procedures. Physicians should customize the letter based on the patient’s actual medical history, diagnosis, and any specific prior authorization requirements.

This is a sample letter template that provides suggestions for writing a Letter of Appeal of a denial of coverage for PFO closure procedures. Physicians should customize the letter based on the patient’s actual medical history, diagnosis, and  any specific appeal requirements.