Claim submission and gender-related edits

Minnesota Health Care Programs (MHCP) cannot accept claims or claims appeals by fax or mail. According to the MHCP billing policy, you must submit all claims electronically through MN–ITS, including claim voids and claim replacements. Submit only the AUC Fax Cover Sheet for Health Care Claims as found on the Electronic Claim Attachments webpage. Do not use the AUC Appeals Cover Sheet. Beginning August 1, 2017, the MHCP claims processing staff will no longer contact you to request your claims electronically. The appeal form and other correspondence will be destroyed if faxed or mailed to us. Beginning July 1, 2017, MHCP will follow Medicare guidelines for processing claims that may deny due to gender-related edits. These edits include conflicts between sex and diagnosis or sex and procedure. Institutional providers (837I) may report condition code 45 (ambiguous gender) to identify claims for inpatient or outpatient services that can be subjected to gender-specific editing (that is, services or diagnoses that are considered female or male only). Use the KX modifier when submitting professional claims to identify services that are gender specific (considered female or male only). The KX modifier will allow gender-specific edits to be bypassed and the claim to process correctly. You must include the KX modifier on each additional claim line.

INDUSTRY NEWS TAGS: Medicaid Minnesota

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