New reimbursement requirements will be initiated for Human Papillomavirus (HPV) test code 87621 (infectious agent detection by nucleic acid [DNA or RNA]; papillomavirus, human, amplified probe technique). Reimbursement of HPV screening is supported for women who qualify to receive the following services: Follow-up of Low-grade Squamous Intraepithelial (LSIL) cytology result in...
The November Update is a list of providers who have been added to the Medi-Cal Suspended and Ineligible Provider List (S&I List) for the month of November. The Medi-Cal Suspended and Ineligible Provider List is updated monthly.
Change Request (CR) 3627, describes new CMS procedures and specific instructions to Medicare contractors (carriers, intermediaries, and DMERCs) for voiding, canceling and deleting claims. As a result of these changes, providers should note that some claims they were able to delete in the past will no longer be deleted from Medicare’s systems, but will instead become denied claims.
CMS received information that a prior instruction (CR3504) did not specifically mention all of the changes that were made to the “Medicare Secondary Payer (MSP) Questionnaire.” CR4098 identifies all of the changes made as part of CR3504 and makes additional changes to the model questionnaire. The official instructions issued to your Medicare carrier or intermediary regarding this change and the...
The amount that must remain in controversy for Administrative Law Judge (ALJ) hearing requests made before January 01, 2006 is $100. This amount will increase to $110 for requests made on or after January 01, 2006. The amount that must remain in controversy for Federal District Court review before January 01, 2006 is $1,050. This amount will increase to $1,090 for appeals to Federal District...
Because administration of the County Medical Services Program (CMSP) transferred to Blue Cross Life & Health Insurance Company (Blue Cross) for dates of service on or after October 01, 2005, CMSP information is being updated in or removed from the Medi-Cal provider manuals.
New Codes Code Current Narrative Medicare Initiated? N348 You chose that this service/supply/drug would be rendered/supplies and billed by a different practitioner/supplier. Yes N349 The administration method and drug must be reported to adjudicate this service. No...
Billing for Blood and Blood Products Under the Hospital Outpatient Prospective Payment System (OPPS). This instruction provides information contained in Change Request (CR) 3681 which compiles and clarifies Medicare procedures and policies for the billing of blood and blood products in the hospital outpatient setting. In particular, hospitals should note the portions of this instruction that...
This article and related CR4144 contain important information regarding: The 2006 annual updates to the clinical laboratory fee schedule Mapping for new codes for clinical laboratory tests Laboratory costs related to services subject to reasonable charge payments It is important that affected laboratories understand these changes to ensure correct and accurate...
Medi-Cal Clinical Laboratory Services Request for Application (RFA) 04-35199 Administrative Bulletin 12 issued by the Department of Health Services (DHS), Office of Medi-Cal Procurement (OMCP) on Sept 19, 2005, announces the cancellation of Request for Application (RFA) 04-35199, Medi-Cal Clinical Laboratory Services. This action is being taken pursuant to Section 8.f. of the RFA and is being...
Code Type Code New/Modified/Deactivated/Retired Current Narrative Comment Remark N345 New Date range not valid with units submitted Not Medicare Initiated Remark N346 New Missing/incomplete/invalid oral cavity designation code Not Medicare Initiated...
The proposed rule adopting standards for electronic health care claims attachments was published in the Federal Register. Health care claims attachments are those documents and information required by health plans to adjudicate certain claims. The proposed rule, mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), adopts two new X12 transaction standards, an HL7...
Providers and suppliers may now apply for their NPI on the National Plan and Provider Enumeration System (NPPES) web site, https://nppes.cms.hhs.gov. The NPPES is the only source for NPI assignment. The NPI will replace healthcare provider identifiers in use today in standard healthcare transactions by the above dates. The application and request for an NPI does not replace the enrollment...
Statewide issuance of the new Medi-Cal Benefits Identification Card (BIC) is now complete. All Medi-Cal recipients should have a new BIC with a 14-character alphanumeric ID number. Recipients who have not received a new BIC should contact their county welfare office.
To facilitate claims processing and track services and items provided to victims of Hurricane Katrina and any future disasters, CMS has established a new condition code and modifier for providers to use on disaster related claims. The new condition code and modifier are for use by providers submitting claims for beneficiaries who are Katrina disaster patients in any part of the country and are...
Medicare Secondary Payer (MSP) is the term used by Medicare when it is not responsible for paying a claim first. When Medicare began on July 1, 1966, it was the primary payer for all beneficiaries, except for those who received benefits from the Federal Black Lung Program, Workers’ Compensation (WC), and those that receive all covered health care services through the Veterans Health...
Providers may link paper attachments to their 837 v.4010A1 Professional electronic health care claims submitted through the Point of Service (POS) device. The Department of Health Services (DHS) is introducing this new process to allow providers who submit electronic claims through the POS device to mail in their paper attachments. To submit paper attachments linked to a POS device claim,...
Medicare will modify the duplicate claim edit to reject all clinical laboratory services submitted to payers when it is determined that another payer has already paid for the same service on the same date of service, with the exception of those claims containing the “91” modifier. This modified edit applies to all laboratory claims with dates of service on or after January 1, 2006. When...
CMS announced that the HIPAA contingency period for claims sent to Medicare would end on October 01, 2005. This termination does not apply to claims that Medicare sends outbound to other payers that have signed a coordination of benefits (COB) trading partner agreement for the transfer of claims by Medicare. It does apply to claims sent to Medicare for secondary payment following processing by a...
California Customer Service and Claims Workloads transferred to Wisconsin, effective October 1, 2005. Customer service telephone lines for both beneficiary and provider customer service are now handled by key UGS Customer Service representatives. There will be very few changes apparent to the provider community. The same customer service you are accustomed to will continue under the same UGS...