Medically Unlikely Edits (MUE) allowable units issue

  • Nov 27, 2017

AHCCCS has determined that there is an issue with the medically unlikely edits (MUE) allowable units on a few procedure codes. DFSM is in the process of identifying the impacted procedure codes and resolve the discrepancies as quickly as possible. Once the corrections have been made, DFSM will run a report of the impacted claims and recycle the claims.

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Anthem to conduct post-service reviews of modifier 91

  • Nov 27, 2017

Beginning in the fourth quarter of 2017, Anthem Blue Cross and Blue Shield in Virginia will conduct post-service reviews of professional claims billed with following modifiers: 25, 62, 80, 81, 82, AS, and 91. Additionally, As part of the review, Anthem may contact providers with outlying billing practices to request additional documentation related to the services. If billing discrepancies are...

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Maintain Financial, Provider, and Professional Records Reminder: Keep Records for Five Years

  • Nov 27, 2017

All providers are required to maintain and retain contemporaneous financial, provider, and professional records sufficient to fully and accurately document the nature, scope, and details of the healthcare and/or related services or products provided to each individual MaineCare member. These records are to be kept for a period of not less than five (5) years in order to meet statutory...

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Claim Edits Effective January 2018- Lab and Pathology

  • Nov 27, 2017

The following claim edits are effective for dates of service on or after January 1, 2018. These policies are derived from CMS, the AMA CPT Manual, HCPCS, ICD-10, nationally accredited societies and Tufts Health Plan policy. The following claim edits apply to Commercial (including Tufts Health Freedom Plan), Tufts Medicare Preferred HMO and Tufts Health Plan Senior Care Options (SCO) products....

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New Medicare Card: New Webpage Information

  • Nov 27, 2017

View new content on the Provider webpage to be ready for the transition to the new Medicare card beginning April 1, 2018. CMS has identified new and updated content as *New*. • Prepare for April 2018 – Sign up for your Medicare Administrative Contractor’s portal now • Help your patients learn about the new cards – Order or print the new poster and tear-off sheets • How CMS is aligning eligibility...

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MolDX welcomes the states of Georgia, Tennessee, and Alabama to the MolDX program and to Palmetto GBA

  • Nov 27, 2017

The MolDX team welcomes the states of Georgia, Tennessee, and Alabama to the MolDX program and to Palmetto GBA. Medicare Part A and Part B providers in the Palmetto GBA Jurisdiction J will be are required to register all molecular tests with the Diagnostics ExchangeTM (DEX), an online test registry. DEX Diagnostics ExchangeTM will assign a unique Z-Code identifier to each molecular test. After...

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Reprocessing of Claims Billed with NCCI-Associated Modifiers

  • Nov 27, 2017

The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain outpatient and medical claims billed with National Correct Coding Initiative (NCCI) associated modifiers. This issue caused claims to erroneously pay. The issue affected claims for dates of service from August 1, 2015, through September 8, 2017. No action is required on your part. Conduent will...

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IHCP will remove age restrictions on certain diagnosis codes and mass reprocess claims that denied inappropriately

  • Nov 27, 2017

The Indiana Health Coverage Programs (IHCP) will remove the age restriction limits in CoreMMIS for specific ICD-10 diagnosis codes. According to information published by the AMA, there are no age restrictions for the diagnosis codes presented. The diagnosis codes in Table 1 may apply regardless of the patient’s age. As noted by the AMA, “These disorders generally have onset within the childhood...

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