Effective March 1, 200. WPS is taking the next step towards full implementation of the NPI in Medicare. Medicare Part B claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim. You may not submit claims containing only a legacy identifier in the...
The following is the latest update of Remittance Advice Remark Codes used in electronic and paper remittance advice and Claim Adjustment Reason Codes used in electronic and paper remittance advice and coordination of benefits (COB) claim transactions. Effective Date: January 1, 2008 New Codes Code Current Narrative Comment N388...
New Codes 80047: Basic metabolic panel (Calcium Ionized- 82330) 82610: Cystatin C 83993: Calprotectin 84704: Gonadotropin, chorionic, (hCG); free beta chain 86356: Mononuclear cell antigen, quantitative, (e.g. flow cytometry), not otherwise specified, each antigen 86486: Skin test; unlisted antigen, each 87500: Vancomycin resistance...
The following contracts have been awarded so far: Highmark Medicare Services On October 24, 2007, CMS awarded the J12 A/B MAC contract to Highmark Medicare Services, Inc (HMS). As the J12 A/B MAC, HMS will immediately begin implementation activities and will assume full responsibility for the work no later than September 2008. Visit their web site. Noridian Administrative...
As of October 29, 2007 all Medicare contractors have lifted the bypass logic and are editing against the Medicare crosswalk. As a result, claims that include non-matching NPIs and legacy identifiers are now rejecting. The following reviews the next set of dates which are crucial for compliance with the NPI regulations. New Codes Date Implementation...
The Department of Health Care Services (DHCS) is extending the current dual-use period, which began on May 23, 2007, to continue beyond the NPI implementation date. Effective November 26, 2007, the NPI implementation date, a Medi-Cal provider number will continue to be required, even though the NPI is also being requested. Failure to include the Medi-Cal provider number beyond the NPI...
In the near future, CMS will be announcing new online enterprise applications that will allow Medicare fee-for-service providers to access, update, and submit information over the Internet. Even though these new internet applications are not yet available, CMS recommends that providers take the time now to set up their online account so they can access these applications as soon as they are...
CMS will be offering a new e-mail update (or listserv) service that delivers Medicare information to Fee-for-Service (FFS) providers, suppliers, and their staffÕs Inboxes. Visitors to the website will be able to sign up to receive updates relevant to Medicare Fee-for-Service providers...
The effective date for the diagnosis restriction policy for Procedure Code 82607 (cyanocobalamin, [vitamin B-12]) has been changed from June 1, 2003 to January 1, 2007.
When laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable analytical chamber, the service may be identified by adding modifier 92 to the usual laboratory procedure code (HIV testing 86701-86703). The test does not require permanent dedicated space; hence by its design it may be hand carried or transported to the...
Once CMS ends its' NPI contingency, the legacy number will NOT be permitted on any inbound electronic and outbound electronic transaction (there are exceptions to the 835 remittance advice (see CR5452)). Medicare contractors will begin rejecting claims, electronic, including direct data entry, that contain legacy provider numbers for any primary provider instead of or in addition to the NPI...
New Waived Tests CPT Codes Effective Date Description 83001QW October 21, 2003 Genosis Fertell Female Fertility Test 84443QW April 2, 2007 Jant Pharmacal Accutest TSH {Whole Blood} 86308QW April 12, 2007 Signify Mono Whole Blood...
Past Medicare Enrollment Practices May Have Contributed to the Use of Incompatible NPI/PIN Combinations. One reason a claim will reject is if the NPI and PIN used in combination on the claim does not identify the same entity. For example, the NPI in the ÒBilling ProviderÓ field might be the corporationÕs NPI, but the PIN used in combination with it might be the physician/practitionerÕs PIN. This...
The Department of Health and Human Services (DHHS) provided guidance regarding contingency planning for the implementation of the NPI. For some time after May 23, 2007, Medicare Fee for Service (FFS) will allow continued use of legacy numbers (Unique Physician Identification Numbers (UPINs) and Provider Identification Numbers (PINs)), as well as accepting transactions with only NPIs. The...
Since October 2, 2006, you have been encouraged to submit both the NPI and Medicare legacy identifier (PIN) on your claims. During this timeframe you were not penalized for invalid NPI/legacy ID combinations. Medicare carriers will begin editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. Where a match cannot be located on the crosswalk, claims will be...
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 13.3, Effective October 1, 2007. The current update reflects the following changes: Modified CP Pairs Column 1 Column 2 Effective Date Policy Mods Effective Date Policy Mods 82270 82272 01/01/2006 More...
Effective for dates of service on or after September 1, 2007, the following procedure codes are benefits of the Presumptive Eligibility (PE) program: 80101 Drug screen, qualitative; single drug class method 86703 Antibody, HIV-1 and HIV-2, single assay 87086 Culture, bacterial; quantitative colony count, urine 87088 Culture, bacterial; with isolation and presumptive...
Effective for dates of service on or after September 1, 2007, HCPCS code S3626 (maternal serum quadruple marker screen including Alpha-Fetoprotein [AFP], estriol, human Chorionic Gonadotropin [hCG] and Inhibin A) replaces HCPCS code S3625 (maternal serum triple marker screen including Alpha-Fetoprotein [AFP], estriol and human Chorionic Gonadotropin [hCG]) as a Medi-Cal benefit. This test is...
Transitioning the Mandatory Medigap (ÒClaim-BasedÓ) Crossover Process to the Coordination of Benefits Contractor (COBC). CMS is transitioning its mandatory Medigap (Òclaim-basedÓ) crossover process from its Part B contractors to the COBC. During the period from June through September 2007, CMSÕ Coordination of Benefits Contractor (COBC) will sign national crossover agreements with Medigap claim-...
Beginning September 17, 2007, claims received on the old HCFA 1500 or UB-92 claim forms will be rejected and returned to the provider. Providers must submit claims on the new CMS-1500 or UB-04 claim form to avoid rejection. Medi-Cal implemented the use of the CMS-1500 and UB-04 claim forms on June 25, 2007. Unfortunately, some providers continue to submit claims on the old forms, so the...