Effective June 14, 2010, WPS Medicare is able to accept redetermination and reopening requests from all J5 Part B providers in Iowa, Missouri, Kansas and Nebraska by Fax. NOTE: The Part B Appeal Fax forms and Fax numbers are distinct from the Fax forms and Fax numbers for Claims Development Resolution. Only submit appeal (redetermination or reopening) requests to the Appeal Fax lines. See...
An article published in the January 2010 Medicare B Update (page 51) of the publication may have led providers to a misunderstanding regarding the correct use of modifier CB (Service ordered by a renal dialysis facility [RDF] physician as part of the ESRD (end-stage renal disease) beneficiary’s dialysis benefit, is not part of the composite rate, and is separately reimbursable). The...
If the State of California does not enact the fiscal year 2010-11 budget by June 30, 2010, the Department of Health Care Services (DHCS) will direct the fiscal intermediary, HP Enterprise Services, to implement provisions pursuant to state law, to continue processing and adjudicating claims as outlined below. HP Enterprise Services will process and adjudicate claims for the following...
Effective for dates of service on or after August 1, 2010, modifier ZS will no longer be reimbursable with MRI, MRA and PET scans. Providers will be required to use modifiers 26 (professional component) and TC (technical component) with CPT codes used to bill MRI, MRA and PET scan services. Source: June 2010 • Bulletin 432
Medi-Cal will implement the 2010 CPT/HCPCS code additions, changes and deletions for dates of service on or after September 1, 2010. Please refer to the 2010 CPT and HCPCS Level II code books for complete descriptions of these codes. Source: June 2010 • Bulletin 432
TriWest Healthcare Alliance Corp. and its claims processor, Wisconsin Physicians Service (WPS), have enhanced the online features of the secure provider portal at www.triwest.com. TriWest and WPS offer an "instant registration" feature, allowing you to authenticate online and receive instant access to your secure account. This enables you to almost immediately access everything you...
TriWest will be offering electronic funds transfer (EFT) for network providers. A pilot program will begin in the summer of 2010. When they are close to implementation, an EFT Enrollment form will be available on www.triwest.com/provider, Find a form. Sign up for the provider eNews at www.triwest.com and watch for updates.
TriWest Healthcare Alliance has created a handout that gives a high-level view of the various TRICARE programs, a short description about each program and a specific section and page number reference in the TRICARE Provider Handbook.
TriWest Healthcare Alliance has implemented some new policies and procedures regarding the use of “Unlisted Codes” to ensure ongoing compliance with TRICARE policy. Unlisted codes include Current Procedural Terminology (“CPT”) unlisted procedure codes as well as Healthcare Common Procedure Coding System (“HCPCS”) – Not Otherwise Classified (“...
UHC successfully deployed enhancements to its 835/Electronic Remittance Advice (ERA) on March 20, 2010. The enhancements apply to UnitedHealthcare Government and other lines of business and focused on changes to the reporting of Member Identification Numbers on 835s. Previously, if a member identification number that was submitted on a claim was different from the member...
As a result of provider feedback, UnitedHealthcare will implement a system enhancement that will consolidate more commercial claims into one payment and will improve the layout of the Provider Remittance Advice (PRA). This enhancement impacts all claims associated with UnitedHealthcare commercial fully-insured and commercial self-funded business. This affects both 835s and paper versions....
The following enhancements apply to UnitedHealthcare Government and other lines of business. You may begin to see these changes starting with 835s and payments received from UnitedHealthcare after June 19, 2010. National Provider Identifier UHC will implement the following changes for Government and other lines of business which will improve the consistency between the National Provider...
For claims with dates of service September 7, 2010 and thereafter, UHC requires rendering providers to submit notification for services ordered by non-participating physicians when no notification is on file, in accordance with the Radiology Notification protocol for commercial benefit plans set forth in the UnitedHealthcare Physician, Health Care Professional, Facility and Ancillary...
UHC will expand the scope of its radiology protocols to include Medicare Advantage Plans offered by SecureHorizons®, Evercare® and AARP® Medicare Complete®. Effective June 7, 2010, UHC will require all participating physicians who are subject to the UnitedHealthcare Administrative Guide to contact them to obtain prior authorization when ordering select advanced imaging...
On April 16, 2010, the Settlement Claims Administrator began mailing the Settlement Notice, claim form and claim form instructions for the UnitedHealth Group UCR settlement to physicians. Physicians will be receiving a plain white mailer with “United Healthcare” written on the bottom and with the return address referencing the Settlement Claims Administrator: United HealthCare...
At the request of several Members of Congress, the Federal Trade Commission is further delaying enforcement of the “Red Flags” Rule through December 31, 2010, while Congress considers legislation that would affect the scope of entities covered by the Rule. Today’s announcement and the release of an Enforcement Policy Statement do not affect other federal agencies’...
Congress failed to address this year’s Medicare physician payment cut before the June 1 deadline this week. Although the U.S. House of Representatives passed legislation at the last minute to suspend cuts for another 19 months, the U.S. Senate left for Memorial Day recess without taking action. When Congress returns from their vacation on June 7, the Senate is expected to take up the House-passed...
CR 6901 announces the latest update of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs), effective July 1, 2010. New Codes - CARC Code Current Narrative Effective Date Per WPC Posting 233 Services/charges related to the treatment of a hospital-acquired condition or preventable medical error. 1...
Below are the changes that will be included in the July 2010 release of Medicare’s edit module for clinical diagnostic laboratory National Coverage Determinations (NCDs). ICD-9-CM codes V17.4 and V18.1 have been deleted from the list of non-covered ICD-9-CM codes for all 23 NCDs; and ICD-9-CM codes V17.41, V17.49, V18.11 and V18.19 have been added to the list of non-covered ICD-9-CM codes for...
CMS is updating edit criteria related to the timely filing limits for submitting claims for Medicare Fee-for-Service (FFS) reimbursement. As a result of the PPACA, claims with dates of service on or after January 1, 2010 received later than one calendar year beyond the date of service will be denied by Medicare. Medicare contractors are adjusting (as necessary) their relevant system edits to...