Billing News Apr 2017



Pricing change for digital breast tomosynthesis and mammography effective April 1

  • April 27, 2017

BCBSAZ wants to notify contracted providers of a revision to their pricing policy related to mammography services. Effective April 1, 2017, BCBSAZ no longer considers the 3D digital breast tomosynthesis (DBT) services to be investigational, and is accepting the 3D DBT codes (77061, 77062, 77063 and G0279) for both routine preventive and diagnostic...

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Provider Refund Form Updates

  • April 27, 2017

New versions of the Provider Refund Form and Provider Refund Form Instructions have been posted under the heading “Provider Forms” on the Provider Policies, Manuals, Guidelines and Forms page of the NCTracks provider portal. Providers who submit refunds should make sure they are following the updated instructions and using the new version of the...

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Issue Corrected: CARC 94 Appropriately Reporting on Remittance Advice (RA) and 835, TR 63097

  • April 27, 2017

When the amount MaineCare pays on a claim exceeds the billed charges, the portion of the paid amount that exceeds the billed charges should be reported on an RA or 835 with CARC 94 (Processed in excess of charges). CARC 45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement) was reported on the RAs and 835s in...

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IHCP to reprocess claims that denied incorrectly with EOB 3001

  • April 27, 2017

With the implementation of CoreMMIS, the Indiana Health Coverage Programs (IHCP) has identified a number of prior authorization (PA) issues – some that have affected claim processing. Providers may have submitted claims on or after February 13, 2017, for reimbursement consideration before the related PA was approved. This would have caused the...

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IHCP will no longer cover chemistry and toxicology tests

  • April 27, 2017

Effective April 28, 2017, the Indiana Health Coverage Programs (IHCP) will no longer cover the following HCPCS codes. This change applies to all IHCP programs for dates of service (DOS) on or after April 28, 2017. HCPCS code Description P2028 Cephalin floculation, blood P2029...

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IHCP will reimburse providers for erroneous claim recoupments

  • April 27, 2017

The Indiana Health Coverage Programs (IHCP) has identified that erroneous accounts receivable recoupments were made between February 13, 2017, and March 24, 2017. These errors affected providers with retro-rate claim adjustments and claim mass adjustments that were processed during that time. Affected providers will be reimbursed for these...

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Hewlett Packard Enterprise Becomes DXC Technology

  • April 27, 2017

On April 3, 2017, Hewlett Packard Enterprise (HPE) split and merged with Computer Sciences Corporation (CSC) to form a new company, DXC Technology. Providers will notice the following changes: • Providers will begin to see the DXC Technology logo or the DXC Technology name on correspondence. • Providers will begin to receive emails from the @...

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Reminder of eTAR Filing for Procedure Codes that Don't Require a TAR

  • April 27, 2017

Providers submitting electronic Treatment Authorization Requests (eTARs) for procedure codes that do not normally require a TAR must select the special handling description “Cannot bill direct, TAR is required,” which is found in the Patient Information section of the eTAR application. Further information can be found in the TAR Overview section...

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