Billing News Jul 2017



Bundling by Tax ID and Specialty Claim Edits Standardization

  • July 28, 2017

On August 1, 2017, Blue Cross and Blue Shield of Alabama will implement the first of its industry standardization claim edits. Currently, bundling edits are applied to claims for an individual provider. For claims processed on or after August 1, 2017, bundling edits will be applied to all providers under the same Tax ID with the same Specialty,...

Read



Ability to suspend Medicaid for incarcerated individuals

  • July 28, 2017

Beginning July 5, 2017, the Health Care Authority’s (HCA) ProviderOne payment system will allow Washington Apple Health (Medicaid) enrollment to be suspended while an eligible client is in jail or prison. Previous policy required eligibility to end during periods of incarceration. Substitute Senate Bill 6430, which was signed into law in 2016,...

Read



Provider Enrollment – Upcoming Process Improvement for Applications

  • July 28, 2017

Conduent is taking steps to reduce the processing time of Provider Enrollment applications, and will be implementing a new process that gives the provider the opportunity to correct and resubmit returned applications sooner. Effective July 31st, Conduent will no longer pend incomplete Provider Enrollment applications. If an application contains...

Read



Abortion Procedure Code 88304

  • July 28, 2017

Since July 1, 2013, some abortion-related claims billed with procedure code 88304 (surgical pathology, gross and microscopic examination) have processed in error. Normally, these claims would pend for nurse review and be subject to a variety of edits. For example, all provider types submitting claims for reimbursement – including any associated...

Read



Requirement for Fingerprint-Based Criminal Background ChecksBackground

  • July 28, 2017

On July 30, 2017, NCTracks will implement a federal requirement for providers designated as "high categorical risk" or any person with a 5 percent or more direct or indirect ownership interest in the organization to be fingerprinted. The requirement is retroactively effective for providers enrolled or re-credentialed on or after August 1, 2015....

Read



Physician Program Rates Reduced by 3%- Laboratory codes

  • July 28, 2017

Effective for dates of services on or after July 1, 2017, the MO HealthNet Division (MHD) Fee-For-Service maximum allowable rates are reduced by approximately three percent (3%) for the Physician Program. These changes are due to reductions included in the Fiscal Year 2018 budget. The MHD will reimburse the lower of the provider’s billed charge or...

Read



G0499 (Hep B Screening) Approved for Physicians and Hospitals

  • July 28, 2017

Effective July 1, 2017, the Department has opened billing for G0499 (Hepatitis B screening in non-pregnant, high risk individuals) under Section 45, Hospitals and Section 90, Physician Services.

Read



Issue Corrected: Denied Claims due to National Correct Coding Initiative (NCCI) Editing

  • July 28, 2017

The issue where some claims have denied in error due to NCCI editing on previously denied claims has been corrected. 

Read