Chronic Care Management – CERT Denials

We have seen an increase in Comprehensive Error Rate Testing (CERT) errors relating to Chronic Care Management (CCM) claims. Please see our Chronic Care Management resource for information about CCM claims and links to additional education. These resources can help providers reduce their claim denials and overpayment recoupments. 

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Outstanding Citibank Checks

Effective February 17, 2026, WPS changed banks from Citibank to US Bank.

To minimize issues in the provider/beneficiary community, please make sure that all received checks issued from the Citibank account (i.e., checks issued February 17, 2026, and prior) are deposited timely prior to the closure of our Citibank account on June 30, 2026. 

After that date, any outstanding Citibank issued checks will become invalid and a replacement check from the new US Bank account will be reissued during the week of July 13, 2026.

Impacted providers/beneficiaries will receive written notification that provides a cross reference from the voided Citibank check number to the replacement check from US Bank.

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J8 Part B Targeted Probe and Educate Problem Error Rates - 96365 is still on the list.  Be sure you are coding this correctly!

WPS conducts Targeted Probe and Educate (TPE) reviews to decrease provider burden, reduce appeals, and improve the medical review/education process. To avoid errors, providers should be aware of problem error rates and top reasons for denial. 

Service Error Rate Group Psychotherapy – 90853 68% Presumptive Drug Test – 80307 55% Wound Care Services – CPT 11042 40% Referring Provider TPE for 99214 35% Intravenous Infusion for Therapy, Prophylaxis, Diagnosis – CPT 96365 31% Intravitreal Injection CPT 67028 with 99211-99215 with modifier 25 30% Cataract Extraction – 66984 18% Outpatient Therapy – CPT 97112 15%

 

For more information, including the top reasons for denial for the three highest error rates, please see the full article on our website.