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Targeted Probe and Educate (TPE)

If you have been affected by Change Healthcare and need relief for any Medical Review Target, Probe, and Education case, please reach out to our Medical Review inquiries mailbox at

What is TPE?

The Targeted Probe and Educate (TPE) program is a medical review process designed to reduce claim denials.

It can include up to three rounds of supplier-specific probe reviews. Each probe review includes a review of 20–40 claims. During and after each round, the supplier will receive one-on-one education on identified errors.

How Are Suppliers Chosen for TPE?

We use data analysis to carefully choose suppliers and items for TPE. Information about the data analysis process is published in the CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 2.2External PDF.

CGS will send written notification to suppliers who are selected for TPE. The letter will include a description of the items to be reviewed, the reason for the review, and an overview of the TPE process.

What Do Suppliers Need to Do if Selected for TPE?

After you receive the initial written notification that you are selected for TPE:

  1. Continue to submit claims to Medicare. Watch for Additional Document Request (ADR) letters related to the items described in the TPE notification.

    Access a list of all your ADR letters in myCGS. Chapter 3 of the DME myCGS User Manual shows you how to find all your open and closed ADR cases and how to respond.

  2. Respond to the ADR. We must receive the documentation requested in the letter within 45 days. Include a copy of the ADR letter with your response.

    You may respond through myCGS, fax, mail (paper, CD, or DVD), or esMD.
  3. Respond to emails and phone calls from Medical Review. If the reviewer identifies an easily corrected error, we contact you to request missing information.

If you forgot to include something in your response and submit the documents late, send an email notification to Do not send PHI via email.

What Happens at the End of a Probe Round?

  • Round 1: If there are no errors in the initial ten claims, we will close the TPE case for the specific item under review.
  • After round 1, 2, or 3: If you show sufficient improvement during claim reviews, we may discontinue your TPE case.
  • You will receive a results letter at the end of each probe round summarizing the claim review results and identifying next steps for your case.
  • We may ask you for a Process Improvement Plan (PIP) when we identify documentation deficiencies or other nonconformances with Medicare polices.
  • We will schedule an educational post probe conference call to discuss claim denials following the completion of each probe round.
  • Suppliers with a high error rate after Rounds 1 and/or 2 will progress to the next round.

What if the Error Rate Does Not Improve?

  • If improvement in Round 1 and Round 2 probes is not sufficient: Suppliers will undergo another round of education followed by another probe review.
  • Following three rounds of probe and education: Suppliers that do not demonstrate sufficient improvement in their error rate will be referred to CMS.

Other MR Activities

If you are selected for TPE, you are not excluded from other MR activities. This includes automated reviews, prior authorization, or other contractor reviews.

CGS will continue to work with other CMS contractors, including the Unified Program Integrity Contractors (UPIC) and Recovery Auditor, to ensure there is no duplication of reviews.

TPE Inquires

If you have questions about the TPE program or need to contact us, please email:



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