Billing News Sep 2017



Authorization requirements for different types of members

  • September 28, 2017

Over the past two months, BCBSMI has received several authorization requests through the e-referral system for procedures for Blue Cross Blue Shield of Michigan PPO (commercial) members that didn’t require authorization. Keep in mind that the list of Services That Require Authorization for procedures that require authorization, as of July 31, 2017...

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Qualis Health Provider Portal (QHPP) Implementation

  • September 28, 2017

Effective September 5, 2017, the State of New Mexico, Human Services Department, Medical Assistance Division, is requiring all Fee-for-Service providers rendering services requiring a prior authorization, all Developmental Disabilities Waiver Case Managers, Mi Via Consultants, and Medically Fragile Case Management, to submit  prior...

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Remittance Advice (RA) Updates – Incorrect Dollar Amounts Reported for Claims Adjustment Reason Codes (CARC) 23 and 45, TR 27287

  • September 28, 2017

Effective October 17, 2017, MIHMS will be updated to correct dollar amounts associated with CARC 23 and 45, populated on the Remittance Advice (RA) and 835. Currently, the system does not populate correct dollar values associated with these CARCs and is sometimes using CARC 94 or CARC 96 in error. 

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Medically Urgent Prior Authorization (PA) Submissions

  • September 28, 2017

Due to the technical issues with the MyHealth PAS Online Portal, if you need to submit a medically urgent PA, please utilize the correct Authorization Form and fax it to 1-207-512-3764. Please check the appropriate field on the Authorization form to ensure that your PA is reviewed appropriately. All non-medically urgent PA requests can be faxed to...

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Medically Unlikely Edits Should Not Deny Claim Lines that Are Prior Authorized, CR 59426

  • September 28, 2017

An issue was discovered where some claim lines were being denied for “medically unlikely” when the claim had a prior authorization. This denial was an error. The system has been updated and affected claims will be reprocessed.  No provider action is needed.

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Issue Corrected: Duplicate Claims Paying Incorrectly, TR 59243

  • September 28, 2017

The issue with duplicate claims payment for some Medicare COBA file claims has been corrected. Claims with an alpha adjustment frequency were not pending for review but instead were being paid automatically.  Affected claims will be reprocessed and no provider action is needed. 

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New Service Type or Address Request Form

  • September 28, 2017

Effective September 1, 2017, the Agency for Health Care Administration (Agency) replaced the New Location Code Request (July 2008) form with the New Service Type or Address Request Form (August 2017). Medicaid providers who are actively enrolled, have no restrictions, sanctions, or over payments, and meet all eligibility requirements can submit...

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Notification of New Out-of-State Provider Application Form

  • September 28, 2017

Effective September 1, 2017, the Agency for Health Care Administration (Agency) replaced the Florida Medicaid Out-of-State Provider Enrollment Application (March 2008) with the Out-of-State Provider Application Form (August 2017). Florida Medicaid reimburses out-of-state providers who provide services to an eligible Florida Medicaid recipient in...

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