IHCP to correct pricing for laboratory codes G0103 and G0434 and mass adjust claims that paid incorrectly

The Indiana Health Coverage Programs (IHCP) has identified a claims processing issue that affects certain fee-for-service claims with dates of service (DOS) from January 1, 2013, through December 31, 2013. Claims billed during that time frame for the following HCPCS G0103 and G0434 codes may have overpaid due to incorrect rates on file. Medicaid reimbursement for individual clinical laboratory procedures cannot exceed the Medicare rate of reimbursement. The rates applied to claims for G0103 and G0434 with DOS from January 1, 2013, through December 31, 2013, did not comply with this requirement. The claims processing system has been corrected with accurate pricing for this time frame. Claims for G0103 and G0434 with the DOS indicated will be mass adjusted. Providers should begin to see the adjusted claims on Remittance Advices (RAs) beginning November 1, 2015, with internal control numbers (ICN) that begin with 56 (mass adjusted). If a claim was overpaid, the net difference appears as an accounts receivable. The accounts receivable will be recouped at 100% from future claims paid to the respective provider number.