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How to Avoid Duplicate Claim Denials

Apr 23, 10:00 AM – 11:00 AM EDT

Provider Enrollment: Submitting Revalidations via PECOS

Apr 23, 10:00 AM – 11:00 AM EDT

Let’s Chat About Provider Enrollment Revalidation

Apr 23, 1:00 PM – 2:00 PM EDT
 
 
 
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Medicare Part B providers administer medically-necessary and preventive services for beneficiaries by diagnosing and treating medical conditions or preventing illness or detecting it at an early stage.

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Duplicate Redetermination Requests Cause Processing Delays

Posted Apr 19, 2019


MLN Connects® for Thursday, April 18, 2019

Posted Apr 18, 2019


Registration is Now Open for the NGS May 2019 Virtual Conference

Posted Apr 16, 2019


National Government Services Now on Twitter!

Posted Apr 11, 2019


MLN Connects® for Thursday, April 11, 2019

Posted Apr 11, 2019

Go to All Production Alerts

Claim Rejections Associated with Reference Lab and Anti-Markup Payment Limitations



Date Reported

3/11/19

Status

Open

Provider Type(s) Impacted

Jurisdiction K and Jurisdiction 6 Part B Providers

Date Resolved

Reason Code(s)

N293

Claim Coding Impact

Laboratory service claims associated with reference lab and anti-markup payment limitation services

Description of Issue

CMS has become aware of an issue concerning invalid rejections of some laboratory service claims associated with reference lab and anti-markup payment limitation services.

National Government Services Action

CMS has instructed the MACs to disable edits associated with these services effective 3/12/2019.

Provider Action

Providers and suppliers who have claims that rejected in error for this editing may resubmit their previously returned claims after 3/12/2019.


Proposed Resolution/Fix

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.

Edit Causing Claims to Reject Containing Procedure Codes 88300, 88302, 88304, 88305, 88307, 88309, 88331, 88332, 88341, 88342 and 88344


Date Reported

3/4/19

Status

Open

Provider Type(s) Impacted

Jurisdiction K and Jurisdiction 6 Part Part B Providers

Date Resolved

Reason Code(s)

CO 97

Claim Coding Impact

Procedure codes 88300, 88302, 88304, 88305, 88307, 88309, 88331, 88332, 88341, 88342 and 88344

Description of Issue

A system edit has erroneously rejected claims containing the procedure codes shown above.

National Government Services Action

CMS has asked all MACs to reprocess all affected claims.

Provider Action

Please continue to check the Production Alerts section of our website and Email Updates for additional status information. 

Proposed Resolution/Fix

3/4/2019: National Government Services will identify and reprocess all claims that were denied in error. Please do not submit appeal requests. This alert will be updated to notify providers when the claims are being reprocessed.  

System Edit Causing Claims to Deny Containing Procedure Codes 93880 and 93882


Date Reported

1/29/19

Status

Open

Provider Type(s) Impacted

JK and J6 Part B Providers

Date Resolved

Reason Code(s)

Group code: C0 16, remark code: M76

Claim Coding Impact

Procedure codes 93880 and 93882

Description of Issue

A system edit has erroneously denied claims containing procedure codes 93880 and 93882.

National Government Services Action

CMS has asked all MACs to reprocess all affected claims.

Provider Action

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.

Proposed Resolution/Fix

NGS will identify and reprocess all claims that were denied in error. Please do not submit appeal requests. This alert will be updated to notify providers when the claims are being reprocessed.

CPT Code 84153 Has Been Inappropriately Denied



Date Reported

12/31/18

Status

Open

Provider Type(s) Impacted

All Part A and Part B Providers

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

CPT code 84153

Description of Issue

CPT code 84153 which is included in the biomarker testing (prior to initial biopsy) for Prostate Cancer Diagnosis LCD (L37733) has been inappropriately denied as a result of a system issue for dates of service 12/1/2018 through 12/30/2018. The issue has now been corrected.


National Government Services Action

Update 1/7/2019:A mass adjustment is planned for impacted claims but has not yet been initiated.

Update 1/9/2019: Mass adjustment for impacted claims has been delayed and is now expected to be completed in early February. Please continue to monitor this site for further details as they become available.

Update 1/22/2019: CPT 84153 continues to edit on NCD 190.31. Providers are advised to consult the NCD guidelines on this code, rather than the NGS LCD.

Update 02/01/2019: Mass adjustment on denied claims has been initiated. Please continue to monitor this site for a notice indicating completed adjustments.

Update 2/4/2019: Adjustments have been completed on impacted claims; the issue is now closed.

Update 2/5/2019: Previous notice of completed adjustments was incorrect; adjustments are now pending initiation. Please continue to monitor this site for notice of completion on the adjustment process.

Update 2/11/2019: Mass adjustment on denied claims have now been initiated. Please continue to monitor this site for a notice indicating completed adjustments.

Provider Action

No provider action is necessary at this time.

Proposed Resolution/Fix

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.

Claims billed with procedure code 99490, that processed between 12/19/2018 and 1/9/2019, denied in error.


Date Reported

1/10/19

Status

Closed

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part B Providers

Date Resolved

1/17/19

Reason Code(s)

CO 97

Claim Coding Impact

Procedure Code 99490

Description of Issue

Claims billed with procedure code 99490, that processed between 12/19/2018 and 1/9/2019, denied in error. This issue was identified and corrected on 1/10/2019. Claims received on and after 1/10/2019 are processing correctly.


National Government Services Action

Affected claims reprocessed beginning on 1/17/2019.

Provider Action

None

Proposed Resolution/Fix

Affected claims will be adjusted beginning on 1/14/2019. Mass adjustments completed 1/17/2019.

Go to All Upcoming Education

Apr 23

10:00 AM – 11:00 AM EDT
How to Avoid Duplicate Claim Denials

Apr 23

10:00 AM – 11:00 AM EDT
Provider Enrollment: Submitting Revalidations via PECOS

Apr 23

1:00 PM – 2:00 PM EDT
Let’s Chat About Provider Enrollment Revalidation

Apr 23

1:00 PM – 2:30 PM EDT
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Apr 24

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