IHCP to update CLIA procedure codes and mass adjust claims

Procedure codes associated with laboratory testing are regulated under the Clinical Laboratory Improvement Amendment (CLIA). Indiana Health Coverage Programs (IHCP) policy requires compliance with CMS recommendations regarding CLIA regulations under all IHCP programs, whether managed care or fee-for-service (FFS). The IHCP identified inconsistencies in the CoreMMIS claim processing system with respect to the classification of certain CPT and HCPCS codes. Effective September 15, 2017, the system will be updated to correct these inconsistencies. Providers with a Certificate of Waiver or a Certificate for Provider Performed Microscopy (PPM) Procedures, as well as providers without a valid CLIA certificate, were inappropriately paid for procedure codes in Table 2. Affected claims will be mass adjusted. Providers should begin seeing adjusted claims on Remittance Advices (RA) beginning September 19, 2017, with Claim IDs/ICNs that begin with 52 (mass adjusted). If a claim was overpaid, the net difference appears as an accounts receivable. The accounts receivable will be recouped at 100% from future claims paid to the respective provider number.

INDUSTRY NEWS TAGS: Medicaid Indiana

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