Clinical Decision Support

  • May 27, 2017

The Protecting Access to Medicare Act of 2014 (PAMA), mandates all referring physicians are required to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services for Medicare patients, performed in specifically identified settings, starting on January 1, 2018. PAMA defines advanced diagnostic imaging services as: CT, MR, Nuclear medicine and PET. Referring...

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AIM Advanced Imaging Program Update

  • May 27, 2017

Beginning July 1, 2017, BCBSND will discontinue the AIM review process. For dates of service prior to July 1, 2017, the AIM process is required. For dates of service on or after July 1, 2017, the AIM process will be discontinued. Advanced imaging will still be subject to medical policy and may be reviewed for medical appropriateness. The BCBSND value-based program, BlueAlliance, focuses on a...

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Payment Error Rate Measurement (PERM) Audit

  • May 26, 2017

In the coming months, you may receive a request for claims information from Chickasaw Nation Industries. Please be advised that this is a legitimate request and is part of the federally mandated Payment Error Rate Measurement Program (PERM). PERM measures improper payments in Medicaid and the State Children’s Health Insurance Program and produces state and national-level error rates for each...

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Provider Manual updated

  • May 26, 2017

UCare has updated several sections of its Provider Manual. The following sections have been changed: Claims & Payment and Medical Necessity Criteria.  

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Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service Claims Processing System

  • May 26, 2017

Change Request (CR) 9911 modifies the Medicare claims processing systems to help providers more readily identify the Qualified Medicare Beneficiary (QMB) status of each patient and to support providers’ ability to follow QMB billing requirements. Beneficiaries enrolled in the QMB program are not liable to pay Medicare cost-sharing for all Medicare A/B claims. CR 9911 adds an indicator of QMB...

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Resubmission of Erroneously Denied Claims for CPT Code 81479

  • May 26, 2017

The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain claims billed with CPT code 81479 (for dates of service from July 1, 2013, to September 16, 2016). This issue caused claims to erroneously deny with Remittance Advice Details (RAD) codes 0196: This procedure requires a modifier; modifier is not present and 0036: RTD (Resubmission Turnaround...

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New Process for Crossover Claims without Medicare Coverage

  • May 26, 2017

Effective May 1, 2017, NCTracks will implement a new edit that will impact all crossover claim types (inpatient and institutional Medicare part A; professional, outpatient and institutional Medicare part B). Medicare part C claims will not be affected by this implementation. The new edit will identify crossover claims (excluding Medicare part C) that indicate a Medicare payment yet no Medicare...

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CMS Releases Lookup Tool to Help Clinicians Determine their MIPS Participation Status

  • May 26, 2017

Unsure of your participation status in the Merit-based Incentive Payment System (MIPS)?  Clinicians can now use an interactive tool on the CMS Quality Payment Program website to determine if they should participate in 2017. To determine your status, enter your national provider identifier (NPI) into the entry field on the tool which can be found on the Quality Payment Program website at...

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