Billing News Jul 2017



New Prior Authorization Request Forms

  • July 28, 2017

Effective July 1, 2017, there will be two new Prior Authorization Request Forms posted in the Prior Authorization Section of the Medicaid website. The following forms will be posted and are required after October 1, 2017. The general Request for Prior Authorization Form should only be used when there is not a specific form for the service(s) being...

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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...

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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...

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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....

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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...

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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.

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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. 

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Authorization numbers for PA requests are no longer case-sensitive in the Provider Healthcare Portal

  • July 28, 2017

Indiana Health Coverage Programs (IHCP) notified providers in IHCP banner page BR201718 that the Provider Healthcare Portal (Portal) required the use of UPPER-CASE letters when keying the alphabetical characters of an authorization number associated with a prior authorization (PA) request. An authorization number that included lower-case alpha...

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