Physician Medicare Crossover Claims Subject to 3 Percent Rate Reduction

N.C. Session Law 2013-360, subsequently modified by Session Law 2014-100, required a 3 percent rate reduction in 10 Medicaid and N.C. Health Choice services. The 3 percent rate reduction for physician services was implemented March 1, 2015, for current claims and going forward. The rate reduction was applied to most previously paid claims over multiple checkwrites in early 2015. However, the Physician Medicare Crossover Claims were not reprocessed during this time. The Physician Medicare Crossover Claims will be reprocessed to apply the 3 percent rate reduction, and overpayments will be recouped. This claim reprocessing was originally planned to begin in April 2017. However, several reprocessed claims in the initial batch denied for edit 01760 - MISSING MEDICARE LINE OTHER PAYER INFORMATION. This issue has been resolved. Applicable Physician Medicare Crossover claims will be reprocessed over the next several weeks and will be reflected in the checkwrites between August 15 and Sept. 26, 2017.

INDUSTRY NEWS TAGS: Medicaid North Carolina

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