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    • November 23, 2013

    Effective 1/1/2014, Wellmark will no longer accept codes 80101 & 80104 for drug screening. Wellmark now follows CMS guidelines, which allow the following two test codes to be reported for drug screen testing: G0434 (Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per... more

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    • March 1, 2014

    In accordance with the CMS direction, National Government Services Appeals Operations for J6 and JK will no longer send a Medicare Redetermination Notice when the review results in a fully favorable determination. However, if the request for the appeal was submitted by an authorized representative of the beneficiary or the provider, letters will... more

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    • January 30, 2015

    On 1/1/2015, CMS introduced the new subset modifiers of 59. CMS believes their usage will help reduce overpayment when subset modifiers (XE, XS, XP and XU) are used appropriately. Modifier 59 will still be valid; however, shall only be used for situations that do not fit the subset modifier descriptions. NGS is proving some additional guidance on... more

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    • September 29, 2015

    NGS 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... more

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    • November 16, 2016

    2017 ICD-10 CM diagnosis codes are required on claims for services performed on or after 10/1/2016. However, changes to the claims processing systems to implement the ICD-10 updates for several CMS National Coverage Determinations (NCDs), including the Lab NCDs, will be implemented beginning in early January, 2017 and will occur in phases over the... more

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    • October 24, 2016

    Beginning 10/1/2016, NGS will return to the provider any paper claim submitted with handwriting on the face of the claim that does not meet the criteria of being a signature field for Items 12, 13, or 31. You will receive a notice attached to the front of the claim when it is returned notating this as well. The only fields on the CMS-1500... more

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    • November 16, 2016

    NGS has been receiving several Paperwork PWK segment submissions of documentation in J6. However, the PWK process has not been put in place in J6 for submission of documentation. J6 still follows the established process that if documentation is required for a claim submission the department needing that information will contact the provider for... more

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