IHCP to update pricing for some genetic testing codes and mass adjust claims

Effective August 15, 2015, the Indiana Health Coverage Programs (IHCP) will update the pricing for the genetic laboratory testing CPT codes found in Table 1. Medicaid reimbursement for individual clinical laboratory procedures cannot exceed the Medicare rate of reimbursement. Therefore, in accordance with the clinical laboratory reimbursement methodology set out in 405 IAC 5-18-1 and the approved Indiana Medicaid State Plan, the IHCP will adopt the 2015 Medicare rates for these clinical laboratory procedure codes. The updated pricing will apply retroactively to dates of service on or after January 1, 2015. Claims processed between January 1, 2015, and August 15, 2015, for the codes in Table 1 were overpaid. Beginning September 1, 2015, affected claims will be mass adjusted to correct the overpayment. Providers should begin to see the adjusted claims on Remittance Advices (RAs) dated September 8, 2015, with internal control numbers (ICNs) that begin with 56 (mass adjusted). Because claims were 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.