Human Immunodeficiency Virus (HIV) Testing-processing issue
September 29, 2015NGS has identified an issue with the processing of some claims for HIV testing NCD 210.7. There have been issues of G0432, G0433, and G0435 paying on claims that did not meet medical necessity according to the National Coverage Determinations. NGS has also identified system issues with claims paying inappropriately outside of the frequency parameters for these services. A correction to the system edits to insure that these procedures are paid appropriately going forward will be implemented on/after 9/1/2015. This is not a change to policy, simply an update to editing to insure proper payments in the future. Also, this will provide notification for providers that may have been paid inappropriately that you will be receiving refund request letters for those services. In J6 there were approximately 2,200 claims that were impacted by this issue. If you receive a refund request letter please make sure that you respond to that letter in a timely manner.
MAC J6 for Wisconsin, Illinois, and Minnesota
MAC JK for Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, Connecticut and New York