Billing News Nov 2017



NEW STATE REGULATION REGARDING ELECTRONIC SIGNATURES FOR THE MO HEALTHNET PROGRAM

  • November 27, 2017

On November 30, 2017, a new state rule (13 CSR 65-3.050) will be effective for electronic signatures in the MO HealthNet Program.  The new rule establishes the basis on which health care providers and participants under Missouri Title XIX programs may use electronic signatures when validating services rendered and received. All providers are...

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Maintain Financial, Provider, and Professional Records Reminder: Keep Records for Five Years

  • November 27, 2017

All providers are required to maintain and retain contemporaneous financial, provider, and professional records sufficient to fully and accurately document the nature, scope, and details of the healthcare and/or related services or products provided to each individual MaineCare member. These records are to be kept for a period of not less than...

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Medically Urgent Prior Authorization (PA) Requests through the Health PAS Online Portal: Medically Urgent Field Added, CR 61353

  • November 27, 2017

An urgent field has been added to the Direct Data Entry (DDE) PA Request Screen on the Health PAS Online Portal. You now have the option to mark your PA as medically urgent before submitting the PA. Prior to this change, you were required to submit medically urgent PA request through fax or mail. MDME now encourages you to submit them through...

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New Medicare Card Replacement Initiative

  • November 27, 2017

On November 20, 2017, MLTC is making changes to the Medicaid Client Eligibility Verification option via the internet, the Nebraska Medicaid Eligibility System (NMES) via telephone, and the 270/271 Eligibility Benefit Inquiry and Response standard electronic transaction. Medicare Health Insurance Claim Numbers will no longer be provided through any...

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UB-04 Claim Denials, CR 58197

  • November 27, 2017

An issue was discovered where some claim lines billed on the UB-04 were denied in error. This issue occurred when the same CPT/HCPC code was billed for the same date of service but the revenue code was different. The issue has been corrected and affected claims will be reprocessed. No provider action is needed.

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Correct Excessive Copay on Multi-Month Claims, TR 50671

  • November 27, 2017

The issue where the system was not correctly calculating copay totals for each month that is limited by the Deficit Reduction Act Maximum (DRA Max) out-of-pocket expenses when the dates of service on the claims spanned multiple months has been corrected. Affected claims will be reprocessed. No provider action is needed. 

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IHCP to revise rates for select clinical laboratory services based on 2018 Medicare rates

  • November 27, 2017

Pursuant to Section 1903(i)(7) of the Social Security Act, Medicaid reimbursement for individual clinical laboratory procedures cannot exceed the Medicare rate of reimbursement. Therefore, in accordance with the clinical laboratory reimbursement methodology set out in 405 IAC 5-18-1 and in the approved Indiana Medicaid State Plan (Attachment 4.19B...

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IHCP will remove age restrictions on certain diagnosis codes and mass reprocess claims that denied inappropriately

  • November 27, 2017

The Indiana Health Coverage Programs (IHCP) will remove the age restriction limits in CoreMMIS for specific ICD-10 diagnosis codes. According to information published by the AMA, there are no age restrictions for the diagnosis codes presented. The diagnosis codes in Table 1 may apply regardless of the patient’s age. As noted by the AMA, “These...

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