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Duplicate Medicare Crossover Claim Adjustments

Fri, 2013-03-29 09:58

There was a problem when changing to the electronic 5010 data set in early January 2012 that resulted in the Department of Public Welfare receiving some claims from the Medicare Crossover process twice resulting in duplicate payments. These duplicate payments have been identified and void adjustments have been processed and appear on this remittance advice. The adjustments can be identified by the ICN range 5213065100001 through 5213065100999; 5213065101001 through 5213065101999; 5213065102001 through 5213065102999; 5213065103001 through 5213065103918; and 5213065612001.

Updates to National Correct Coding Initiative (NCCI)

Tue, 2012-11-27 09:35

The Department of Public Welfare (Department) will implement Phase 2 of National Correct Coding Initiative (NCCI) program edits for claims received on or after November 1, 2012. The second phase incorporates Medically Unlikely Edits or procedure code limits as defined by CMS. This phase also includes changes to edit messages. CMS simplified NCCI Procedure-to-Procedure edits by consolidating Incidental code pairs and Mutually Exclusive code pairs into one edit category.

Reprocessing Procedure Code 87807 Claims

Thu, 2012-09-27 10:16

Procedure code 87807 (Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus), is a service that may be provided to recipients aged 0 to 120. On June 14, 2011, the age range was inadvertently changed allowing only individuals under the age of 1 to be eligible for this service. The age range was corrected on March 12, 2012, and the Department of Public Welfare identified claims that denied with Error Status Code (ESC) 4034 (procedure code vs. age restriction).

Jurisdiction H Award of Part A/B MAC Contract

Sun, 2012-04-01 17:00

In November 2011, CMS announced the selection of Highmark Medicare Services Inc. as the new Medicare Administrative Contractor (MAC) for handling both Medicare Part A and Part B fee-for-service claims in Jurisdiction H, which includes the states of Louisiana, Arkansas, Mississippi, Texas, Oklahoma, Colorado, and New Mexico. A protest was filed but denied. CMS will issue the new transition schedule shortly.

XIFIN 5010 Readiness Update

Thu, 2011-12-22 16:00

XIFIN is leading the industry in 5010 readiness by leveraging its expertise, claim submission surveillance tools and payor relationships to submit production 837 medical claims and receive production 835 remittance advices well in advance of the January 1, 2012 deadline to ensure that customers experience no interruption in claims processing related to this government mandate.

Unsolicited Return of Money - Part B

Thu, 2011-11-17 16:00

To facilitate prompt and accurate credit of unsolicited monies or voluntary refunds to Medicare, a Return of Monies form has been developed. Please use the Return of Monies form (8322) for Part B if you receive a Medicare payment in error.

Unsolicited Return of Money - Part B

Thu, 2011-11-17 16:00

To facilitate prompt and accurate credit of unsolicited monies or voluntary refunds to Medicare, a Return of Monies form has been developed. Please use the Return of Monies form (8322) for Part B if you receive a Medicare payment in error.

Analysis of Part B CERT Data (July - September 2010)

Sun, 2010-11-21 16:00

During the third quarter, 52 CERT errors were assessed for all Part B contracts within J12. Of those 52 errors, 18 errors were due to insufficient documentation, 5 were due to medical necessity and 29 were due to incorrect coding.

Analysis of Part B CERT Data (July - September 2010)

Sun, 2010-11-21 16:00

During the third quarter, 52 CERT errors were assessed for all Part B contracts within J12. Of those 52 errors, 18 errors were due to insufficient documentation, 5 were due to medical necessity and 29 were due to incorrect coding.

Interactive 1450 (UB-04) Form

Wed, 2010-09-01 09:55

To assist electronic billing customers with error messages received on the electronic reports, an interactive 1450 (UB-04) form has been developed as a crosswalk. This crosswalk is an interactive feature that displays the appropriate loops, segments, and qualifier detail when clicking on each block of the 1450 (UB-04) sample claim form. A crosswalk chart is also available to provide a complete list of the crosswalk information.

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