Jurisdiction C Adds Prepay Review for CPAP

NASHVILLE–Cigna Government Services, the Jurisdiction C DME
MAC, said yesterday it will begin a service-specific prepay review
for HCPCS code E0601, CPAP device, “as a result of data
demonstrating a high claims payment error rate for this product
category.”

If the language sounds familiar, it is. On Friday (Aug. 21), the
DME MAC made the same announcement for oxygen claims.

The latest notice said CPAP claims will be developed for
additional documentation, and providers who receive development
letters will be asked to submit any requested documentation. That
could include the following:

• Physician’s order;
• Documentation from face-to-face evaluations;
• Copy of sleep test;
• Documentation of adherence to therapy; and
• Proof of delivery and product information.

The information must be received within 30 days of the date of
the letter or the claim will be denied, according to the Cigna
message. Jurisdiction C covers Alabama, Arkansas, Colorado,
Florida, Georgia, Louisiana, Mississippi, New Mexico, North
Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas,
U.S. Virgin Islands, Virginia and West Virginia.

Read the entire notice on the CPAP prepay review here.