Billing News Jun 2017



EWC: Erroneous Payment Correction Planned for Breast Screening/Diagnostic Services

  • June 27, 2017

Every Woman Counts (EWC) providers are encouraged to submit claims for breast cancer screening and diagnostic services for symptomatic recipients 40 years of age or younger per Assembly Bill (AB) 1795 (Atkins, Chapter 608, Statutes of 2016) amending Section 104150 of the Health and Safety Code. The Medi-Cal claims processing system is being...

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Update to claims processing edits and reimbursement policies

  • June 27, 2017

On June 1, 2017,  BCBSGA will be updating the following new and/or revised reimbursement policies. Effective January 1, 2017, BCBSGA is documenting their current edit that denies 82570 (urine creatinine) or 83986 (urine pH) when reported with 80305-80307 (presumptive drug testing) and G0659 (definitive drug testing). In addition, for claims...

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Updates to CLIA-Waived CPT Codes for Infectious Agent Antigen Detection

  • June 27, 2017

Effective for dates of service on or after July 1, 2017, when performed with a Clinical Laboratory Improvement Amendments (CLIA)-waived test kit, CPT codes 87338 (infectious agent antigen detection by immunoassay technique, qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool) and 87806 (infectious agent antigen...

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Procalcitonin Assay Added as a Benefit

  • June 27, 2017

Effective for dates of service on or after July 1, 2017, CPT code 84145 (procalcitonin [PCT]) assay is a new benefit. It is indicated in any of the following clinical situations: determine if antibiotic treatment should be started or stopped in recipients with lower respiratory tract infections; determine if an antibiotic should be stopped in...

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Reprocessing of Erroneously Paid and Denied Claims Billed with Certain ICD-10-CM Codes

  • June 27, 2017

The Department of Health Care Services (DHCS) identified a claims processing issue with some claims billed with ICD-10-CM diagnosis codes O04.5, O04.6, O04.7, O04.8, O04.81, O04.82, O04.83, O04.84 and O04.89. This issue caused some claims to erroneously pay, while other claims were erroneously denied with Remittance Advice Details (RAD) codes 0169...

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Resubmission of Erroneously Denied Split-Billable Claims

  • June 27, 2017

The Department of Health Care Services (DHCS) identified a claims processing issue affecting split-billable claims with no modifier. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 0095: This service is not payable due to a procedure, or procedure and modifier, previously reimbursed. The issue affected claims...

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Resubmission of Claims Billed With ICD-10-CM Code N94.89

  • June 27, 2017

The Department of Health Care Service (DHCS) identified a claims processing issue affecting ICD-10-CM diagnosis code N94.89 (other specified conditions associated with female genital organs and menstrual cycle) claims billed with CPT codes 84702 (gonadotropin, chorionic [hCG]; quantitative) or 84703 (gonadotropin, chorionic [hCG]; qualitative)....

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Resubmission of Erroneously Denied Laboratory Services Claims

  • June 27, 2017

The Department of Health Care Services (DHCS) has identified a claims processing issue affecting some laboratory services claims. This issue caused claims to erroneously deny with Remittance Advice Details (RAD) code 9655: The monthly frequency limits for this procedure have been exceeded. Please appeal with justification for exceeding the...

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