Billing News May 2017



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...

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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...

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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)...

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Possible Amendment to Rules Governing Retroactive Billing

  • May 26, 2017

The Minnesota Department of Human Services requests comments on its proposed amendment to the rules governing retroactive billing for medical assistance providers and reimbursement of medical assistance recipients at part 9505.0540, subpart 3. Under the current rule, if a recipient was determined retroactively eligible for medical assistance, and...

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Issue Corrected: Incorrect Copayments, TR 51231

  • May 26, 2017

The issue where some copayment amounts were not being calculated correctly when there was more than one line on the claim has been corrected. Affected claims will be reprocessed. No provider action is needed.

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QMB/Spenddown Claims Denied in Error, CR 56707

  • May 26, 2017

An issue was identified where some crossover claims denied in error. The error occurred when the member had Medicare for primary insurance and Qualified Medicare Beneficiary (QMB) coverage with a spenddown as secondary insurance. The claim should have processed with QMB coverage, but instead denied in error. The issue has been corrected and claims...

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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...

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IHCP allows providers until September 1, 2017, to update rendering provider linkages

  • May 26, 2017

The Indiana Health Coverage Programs (IHCP) has received a number of inquiries from providers about claim denials for explanation of benefits (EOB) 1010 - Rendering provider is not an eligible member of billing group or the group provider number is reported as rendering provider. Please verify provider and resubmit. As announced in previous IHCP...

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