UCare – Temporary Suspension of Medicare Claim Processing Edits

Effective for Medicare claims with 2020 dates of service, processed after July 21, 2020, UCare is temporarily suspending certain claims processing edits for claims submitted on behalf of members in the following products: UCare Medicare Plans, UCare Medicare with M Health Fairview and North Memorial, and EssentiaCare. This temporary suspension will be in place for a minimum of 30 calendar days and until further notice. UCare is working through system enhancements and has made the decision to implement this suspension to prevent delaying payment to our providers. This means providers may receive payment for services that may have previously denied. Effective for Medicare claims with 2020 dates of service, processed after July 21, 2020 (and until further notice):

• UCare has temporarily suspended certain claims processing edits for Medicare members claims for Part B medical, drug and durable medical equipment (DME) services.
• This includes new claims, reprocessed claims, replacement claims, adjusted claims, and/or void/reinstated claims.
• During this edit suspension period, UCare will pay claims for covered services for our Medicare members without applying certain edits that may have previously caused a claim to deny.
• UCare expects all providers to continue to bill covered services following Medicare guidelines and that medical necessity criteria is met for all services delivered and billed.
• Although UCare will not proactively reprocess/recoup claims processed during this period, UCare reserves the right to retroactively audit services for medical necessity and recoup payment for those services that did not meet criteria.

Source: https://docs.ucare.org/filer_public/files/bulletin_2020_july21_ceseditsuspension.pdf