Billing News Oct 2017



Medicaid Secondary Claims Where Cost Share Does Not Apply, and Contractual Obligations Reporting on Medicaid Secondary ClaimsShare

  • October 25, 2017

N.C. DHHS will implement in NCTracks new business rules for processing Medicaid secondary claims and claim adjustments where a Third-Party payer made a payment on the claim and Cost Share (Patient Responsibility) was not applicable. Specific coordination of benefit (COB) payer filing indicators will identify Third Party claims that will price...

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Medicaid Secondary Claims Submitted with CARC Code 97CARC-Update

  • October 25, 2017

The NC Division of Medical Assistance (DMA) is suspending the new Medicaid secondary claims editing related to Claim Adjustment Reason Code (CARC) 97 (The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated) that was communicated in the May 2017 Medicaid Special Bulletin....

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Drug Testing For Opioid Treatment and Controlled Substance Monitoring

  • October 25, 2017

N.C. Medicaid has drafted a new medical policy outlining the requirements and limits for drug testing for opioid treatment and chronic pain management. N.C. Medicaid held a stakeholder meeting in October 2016 and reviewed the comments, concerns, and suggestions shared by providers at that time. The new policy mirrors Palmetto Local Coverage...

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Crossover Adjustment Claim Overpayment, TR 72093

  • October 25, 2017

An issue has been identified where some crossover adjustment claims are creating duplicate payments. This happens when the original claim is not detected in the system; therefore, it is not reversed. This results in an overpayment. MDME is working to correct this issue and will send out a notification when it is resolved.

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Payment Error Rate Measurement Information for Medicaid & CHIP Providers Regarding Medical Record Requests

  • October 25, 2017

The Payment Error Rate Measurement (PERM) program measures improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) and produces error rates for each program. The PERM error rates are based on reviews of fee-for-service (FFS), managed care, and eligibility components of Medicaid and CHIP in the federal fiscal year (FFY...

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Medicaid Managed Care Program effective January 1, 2018

  • October 25, 2017

The Department of Health and Social Services (DHSS) announced September 29, 2017 that it has selected two companies to operate its Medicaid Managed Care Program effective January 1, 2018. DHSS’ Division of Medicaid and Medical Assistance (DMMA) has announced its intent to enter into a new contract to continue its Managed Care Organization (MCO)...

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Professional claims are denying with EOB 1050

  • October 25, 2017

DMMA and DXC Technology continue to work toward solutions to resolve the challenges you are experiencing. They are aware of the following claim denial and additional communication will be forthcoming: Professional claims are denying with EOB 1050 - Medicare Coinsurance or Payment is not Within an Allowable Range when primary insurance is a...

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Professional Regulation Goes Electronic

  • October 25, 2017

Beginning November 1, 2017, the Delaware Division of Professional Regulation (DPR) will send notices regarding professional licenses by email only. Paper letters, including renewal notices, will no longer be mailed. DPR is currently in the process of mailing notifications to licensed health care professionals. To be sure you receive important...

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