PRESENTERS - PLEASE FOLLOW UP ON QUESTIONS NOTED UNDER YOUR CATEGORY THANKS FOR BEING ONLINE TODAY!!!
WELLCARE - NO UPDATE BUT PROVIDER INQUIRY SHARED:
Inquiry:
Atlanta: Tanner Medical Center, Infusion: add-on codes billed on diff DOS from the primary
code
+++++++++++++++++++++++++++++++++
Claims Inquiry Response:
The attached Infusion claims denied add-on codes IH013 for no base code billed. However, the
base code shows in history at least 24 hours or more prior to add on. Per hospital manual,
certain infusion codes do not require the base code to be submitted on the same day. CCT is
aware of this issue and has already modified the edit from May release. A project is currently
pending to capture and reprocess all claims that have denied in error through Scripting however
estimated completion time is unknown. No action is necessary from the provider. Issue closed
7/9/12
Vicki Walker
Sr. Provider Relations Representative
AMERIGROUP PROVIDER UPDATE:
Please refer to nichole.sharps@amerigroup.com
Wellpoint has entered into an acquisition agreement with Amerigroup.
For more information on the acquisition you can listen to the Conference Call:
Number - 1-800-475-6701
Access: 254066
PEACH STATE UPDATE:
Nancy Bunke
PEACH STATE QUESTION:
we were told by our Peachstate representative that Therapeutic IM Injection codes 96372 are not
payable by Peachstate unless they are billed with J1055 (Depo-provera) or J1051 for family planning or
with Chemo drugs. Is this information correct? Reply to Darlene Martin - dmartin@optimhealth.com
HP / MEDICAID 5010 UPDATE DELANO - HIPAA 5010
July 1st full 5010 implementation going well
BILLIE WEBB
HP Medicaid Incentive Program Rep
678-713-3726
Hp.mapir.outreach@hp.com
www.dch.ga.gov
JANEY GRIFFIN
Outliers are now being processed. If you have submitted your ICN numbers - they have been sent to
DCH. If you submitted to Janie, allow 30 days then send the CTN to Janie stating that you have not
received.
Make sure to Communicate through the Contact Center:
https://www.mmis.georgia.gov/portal/PubAccessHome/tabid/36/sessionredirect/true/Default.aspx Give them 10 days to respond.
Lab Bundled Charges - Provider submitted on individual lines instead of bundling them on a panel. This
caused the claim to overpay
HP is going to mass process- PLEASE HOLD - Do not refund - No timeline
NEW PROCESS IN P&P Manual 1 Section 502.1
Providers have been submitting a lot of Administrative reviews to DCH. The Manual states before you
can request a review you must start off by submitting a DMA-520 or 520-A. You have 30 days for the
appeal to come over to GMCF. If you fail to adhere to this process, the decision will not be overturned.
EXAMPLE:
Claim denies for untimely filing. Provider must produce documentation to prove timeliness of claim. (90
days to correct a claim to keep it timely.) If claim denies, must submit with DMA-520 within 30 days Please see all documentation. IF this is denied. Then you can proceed with the administrative review.
QUESTIONS:
Procedure Code for 2 mg of Morphine - billing J2270 morphine up to 10 mg is NOT on the list. J2275 per
10mg is on the list - MUST SUBMIT APPEAL IN THE MEANTIME - and request for code to be added.
NDC Codes not recognized by Medicaid - Does the company have to listed to be reimbursed? JANIE will
let us know
Telemedicine - No contract for billed procedure code Q3014-GT - Revenue Code 780
Category of Service? Outpatient - Not covered for this procedure code. - Kathy noted that you should
follow up with Paula or Rena at GPT.
To HP: When will nursing homes get the PASSAR Level II numbers that were being produced by APC
Healthcare? Not all have been received yet JANIE will let us know
Does Medicaid require a pre-cert when it is secondary to Medicare Advantage? No unless it is an
Inpatient Part B Only. No ICN available. Janie is checking further
OK - so we get a RA with denial. We go online and try to correct claim within 90 days. THEN it is denied
again. Do we have 30 days from corrected claim denial OR 30 days from 1st denial?
If it is denying for the same reason - you have 30 days to submit with the DMA-520 and if it denying
for a new reason then you have 90 to correct on the portal for the new reason.
How long to receive resolution? You get a response that it has been received for a review, then you
will get resolution within 30-45 business days.
DMA-520A goes to GMCF and you will receive a skew number and you can track claim and make sure
to submit in the order that they are asking.
JANIE - Effective 7/1/12 medicaid crossover claims of patients with Medicare QMB coverage were to
start reimbursing the max medicaid allowable. I have a lot of claims deny with code 4801 and 4802 and
stating the claim was submiited before 45 days. These were crossed over and not hard copy claims. Are
you having problems with these? Beverly Reynolds, SW GA Nephrology Cl, Albany, GA
- These have been corrected - JANIE _ CONTACT NUMBER Beverly Reynolds bmreynolds55@yahoo.com - 229 -888 3970
DALE GIBSON - MEDICARE UPDATE:
CLAIMS ARE ON HOLD FOR THIRD QTR UPDATE - Check on this!
SEE THE http://hometownhealth.wikispaces.com/Medicaid+Look+Up for all the documents that Dale
referred to.
After Oct 1st - Changes to Dialysis claims - READ UPDATE TO ENSURE THAT YOU ARE BILLING CORRECTLY!
Thanks for being online today!!
Kathy
Kathy Whitmire,
Managing Director
HomeTown Health, LLC
www.hometownhealthonline.com
Home Office: 706-886-9543
Cell Phone: 706-491-3493