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Michigan Medicaid

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Michigan Medicaid REIMBURSEMENT UPDATES WINTER 2012/2013 Presenter-Catherine Caswell * *Revised 01/16/2013 – PowerPoint PPT presentation

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Title: Michigan Medicaid


1
Michigan Medicaid
  • REIMBURSEMENT UPDATES
  • WINTER 2012/2013
  • Presenter-Catherine Caswell

2
Agenda
  • Hospital edit changes for OPH/IPH
  • Coding Updates
  • Policy Clarifications
  • New policy Review
  • Proposed policy review
  • CHAMPS Payment Schedule Posted
  • Mass Claim Adjustment Schedule
  • Suspended Claims Activity
  • Questions Contact Information

3
NEWS-editing we are working on will affect your
Out-Patient Hospital claims
4
News-future changes!
  • Did you know that Michigan Medicaid policy states
    that per APC Policy A single OPH episode of
    care is to be billed on one claim in order to
    group/price edit the OPH visit under the APC
    methodology?
  • Here is what Medicaid Policy states
  • CHAPTER Billing Reimbursement for
    Institutional Providers
  • Section 7.1.E Date of Service
  • All services for a single outpatient encounter
    must be reported on one claim, except for
    Medicares allowable repetitively billed services
    and hospital-owned ambulance services. MDCH
    aligns closely with Medicare's guidelines for
    monthly repetitive billing.
  • Projected correction date to the system 4.7
    04/26/2013

5
News
  • MOMS and/or ESO Benefit Plan claims appear to be
    paying voluntary sterilizations. This is a
    non-covered service. Projected to be corrected in
    future.
  • Compound Drugs have an issue with NDC's after
    5010 implementation-denying as duplicates.
    Projected 4.6 02/15/2013
  • CHAMPS manage claims-trying to change a PRO but
    system keeps saving the original data only.
    Fixed 4.4 09/28/2012 Release
  • Effective 06/22/2012 system started paying only
    up to charges billed instead of up to the APC
    rate. Fixed 4.4 09/28/2012 Release
  • Effective 06/22/2012 system is not deducting
    Value Code 66 for the spend-down/deductible .
    Projected to be corrected in the future

6
News
  • Per MDCH-Bulletin Number MSA 10-60-effective for
    DOS on/after 1/1/11 (following CMS rules) All
    non-diagnostic services rendered in the 3 day
    window prior to the Inpatient hospital admission
    may not be billed separately and must be bundled
    into the DRG Stay. Hospitals may document the
    "unrelated" OPH services by appending condition
    code 51 to the OPH claim. Need new edit
    developed to suspend/deny OPH claims billed w/o
    condition code 51 within 3 days of an IPH claim.
    Projected (was 4.6 02/15/2013) ) now delayed due
    to budget constraints

7
News
  • Enhancement to create additional logic to deny
    service lines on IPH and OPH claims with
    professional charges. (Projected 4.7
    04/26/2013 ) now delayed due to budget
    constraints
  • Currently we do mass sweeps quarterly and void
    out miss-paid claims.
  • Providers have asked for this enhancement as
    Medicare Crossover claims from CCA facilities
    bill this way
  • Will reject revenue codes that should be used to
    reflect professional fees (96X, 97X, 98X)

8
News
  • Service lines billing drug codes throwing an
    erroneous error as not rebate-able (providers
    remittance advice would show adjustment reason
    code 211-NDC not eligible for rebate, are not
    covered and remittance remark code M119)
  • Problem identified 09/12/2012
  • Error has to do with emergency logic to the
    cross-over claims sent without a service line
    date of service-
  • Work around is for provider to adjust and ADD
    those service line dates to their claims.

  • Projected
    correction4.6 release 02/15/2013

9
News
  • Logic enhancement as a result of ICD-10 to
    redesign so that all diagnosis codes on the claim
    will compare to the procedure code
  • Currently suspend several claims to manually
    review all subsequent DX codes
  • Future (not
    assigned to a release)

10
NEWS-editing we are working on will affect your
In-Patient Hospital claims
11
News-future changes to look forward to!
  • Needs working bypass for admit source 5
    (transferred from SNF) within our Patient Pay
    Logic. Per policy when patient is living in a
    Skilled Nursing Facility and is transferred to an
    In-Patient Hospital setting we should normally
    bypass deducting the PPA from the first month
    service however currently we are immediately
    taking the PPA Projected (was 4.6-02/15/2013 )
    now delayed due to budget constraints
  • Co-Pay Deducted (50.00) when transfer in's, per
    policy system should not deduct a copayment.
    Provider may see CARC 3. Projected (was
    4.6-02/15/2013 ) now delayed due to budget
    constraints
  • Enhancement to information appearing in the Claim
    Limit List will show readmit within 15 days the
    date span involved and the NPI etc. Currently
    providers must call or email PPS to obtain this
    information if patient was in a facility other
    then their own.
  • Projected (was 4.7-04/26/2013 ) ) now
    delayed due to budget constraints

12
News
  • CHAMPS Direct Data Entry issue with the
    occurrence span codes/dates Fixed 4.5 12/02/2012
  • Screens let user enter up to 12 entries
  • Claims fail to load as CHAMPS logic only allows
    for 4 of these fields-need to expand to allow for
    correct number of these fields (black hole
    effect)
  • CHAMPS Direct Data Entry issue with the other
    payer amount paid field Fixed 4.5 12/02/2012
  • Screens let user enter more then 10 characters
  • Claims fail to load-need to restrict DDE to 10 or
    less characters

13
News
  • Logic regarding other insurance needs to be
    further modified Projected 4.6 02/15/2013
  • Have claim rejection for other insurance when the
    only other coverage type RX

14
News
  • Logic regarding PACER requirements needs to be
    further modified. Projected (was 4.7
    04/26/2013) but now pushed back to 4.8
    06/28/2013
  • Claims with admit source transfer (4 or 6)
    regardless if admit type is urgent/emergent

15
Updates Coding-Out-Patient Hospital
16
Out-Patient Hospital Coding Updates
  • 094X Revenue Code was included in Plan First
    Benefit Plan(PFBP) and is not now.
    Resolved-determined not an appropriate revenue
    code to bill for PFBP Issue resolved as of
    08/20/2012
  • G0166 is listed on the WRAP AROUND CODES list
    database as of October 2011, with an R1 indicator
    reflecting its MDCH non-covered item. (On the CMS
    Addendum B list this code is status indicatorT.)
    However we are trying to obtain clarification if
    this code should be listed as MDCH non-covered
    prior to October 2011 as current claims
    processing we are noticing claims are rejecting
    as non-covered in that prior date range. Problem
    identified 09/17/2012

17
Out-Patient Hospital Coding Updates
  • Individual and group counseling codes for
    diabetes training and education. Receiving
    inquiries regarding G0108 and G0109 as these are
    the payable codes under Medicaid for providers
    that are certified to provide this service.
    These codes should be listed on the wrap around
    codes list as on Addendum B the status indicator
    is set to an A. We are working with policy
    regarding correction of this issue. (Claims
    billed correctly are paying correctly this is a
    documentation issue only and has been ongoing
    issue from legacy.)
  • Dialysis providers inquiry if Q2047 is payable by
    MA? On Addendum BStatus Indicator of A but is
    not on the wrap around codes list. We verified
    that code is paying-referred issue to policy to
    further determine if we should or should not be
    paying this code and if the Wrap Around Codes
    list needs to be updated. (Identified and
    reported 01/03/2013)

18
Out-Patient Hospital Coding Updates
  • We are receiving multiple inquiries regarding
    therapy reimbursement. There is posted on our
    provider specific information website a data base
    for therapy codes that seems to imply that this
    is what we cover, frequency, modifier
    requirements etc. Therapy is paid from CMS
    guidelines and here are some web sites you may
    wish to use to explain our reimbursement further
  • To see if the specific therapy code REQUIRES a
    modifier (sometimes/always) see
  • http//www.cms.gov/Medicare/Billing/TherapyService
    s/AnnualTherapyUpdate.html
  • To see FEE SCHEDULES for therapy codes go to
  • http//www.cms.gov/Medicare/Billing/TherapyService
    s/index.html?redirect/TherapyServices need
    to use MPPR rate file (Multiple Procedure Payment
    Reduction)

19
Out-Patient Hospital Coding Updates
  • We identify OPH therapy claims by APC Status AT
    on the line.
  • The multiple procedure payment reduction will be
    applied for a therapy procedure when more than
    one unit or more than one procedure is provided
    to the same patient on the same date of service.
  • Full payment is made for the unit or procedure
    with the highest payment. For subsequent units
    and procedures furnished to the same patient on
    the same day, the 25 reduction is used (25 is
    the rate for services furnished in an
    institutional setting).
  • When using the fee schedule data base you will
    need to be sure to use your CARRIER/LOCALITY to
    get the correct amounts.
  • Use fee amount and then apply the appropriate
    Michigan Medicaid Reduction Factor.
  • Or if / when appropriate select the 25 reduction
    column and then apply the Michigan Medicaid
    Reduction Factor.

20
Policy Clarification/Hospital-Proposed Medicaid
Changes
21
Eligibility change
  • New Benefit Plan ID MME-MC
  • Medicaid-Medicare Dually Eligible Managed Care
  • Starting 12/14/2012 providers will notice for
    beneficiaries dually covered by Medicaid and
    Medicare that are enrolled in a Medicaid Health
    Plan will have this special Benefit Plan ID
    designation in CHAMPS.
  • There are no changes to the benefit coverage's.
    AND this benefit plan designation will show for
    enrollment dates of service 10/01/2012 and
    ongoing.

22
MSA-12-40- -Michigan National Correct Coding
Initiative Update-Effective 10/01/2012
  • Policy issued in August 2012 states that in
    further accordance with the Section 6507 of the
    Affordable Care Act of 2010 in requiring that
    State Medicaid programs use National Correct
    Coding Initiative(NCCI) policies and edits to
    process claims. The purpose of the Medicaid NCCI
    is to prevent improper payments when incorrect
    code combinations or units are reported.
  • CMS has reviewed and reduced Medically Unlikely
    Edits (MUEs) for bilateral surgical procedures.
    Providers will be required to bill with quantity
    of 1 and use of modifier 50. Billing otherwise
    (with a quantity of 2 or with modifiers of LT or
    RT etc. on multiple lines) will be considered
    non-compliant billing. Claims will be rejected
    (not cut-back).
  • Current MUE values can be found on the CMS
    website http//www.medicaid.gov/Medicaid-CHIP-Pro
    gram-nformation/By-Topics/Data-and-Systems/Nationa
    l-Correct-Coding-Initiative.html

23
MSA-12-46- Policy regarding enrollment of
CSHCS/MA beneficiaries into MHP Effective
10/01/2012
  • Effective 10/01/2012 beneficiaries dually
    enrolled in CSHCS and Medicaid will transition
    from an excluded population to a mandatory
    population for purposes of MHP enrollment.
  • Effective 10/01/2012 these beneficiaries will no
    longer be retroactively dis-enrolled from a MHP.
    (CSHCS split-billing exception is rescinded)

24
MSA-12-46
  • Providers are responsible for verifying a
    beneficiarys eligibility and enrollment status
    prior to rendering service. The CHAMPS
    Eligibility Inquiry transaction indicates a
    Benefit Plan ID of CSHCS-MC for a CSHCS/MA
    beneficiary enrolled in an MHP. Providers must
    bill the appropriate payer for all services
    rendered.
  • CSHCS/MA beneficiaries enrolled in an MHP,
    including beneficiaries age 21 and over, are
    exempt from MHP copayment requirements for all
    Medicaid covered services.

25
MSA-12-46
  • Exclusions
  • CSHCS/MA beneficiaries without full Medicaid
    coverage (e.g., Medicaid Deductible, Emergency
    Services Only, Qualified Medicare beneficiaries,
    Special Low Income Medicare beneficiaries,
    Additional Low Income Medicare beneficiaries,
    etc.)
  • CSHCS/MA beneficiaries excluded for other reasons
    such as medical exception, incarceration, or
    enrollment in commercial health maintenance
    organizations (HMOs) or preferred provider
    organizations (PPOs)
  • CSHCS/MA beneficiaries who meet any of the
    excluded criteria described in the Medicaid
    Provider Manual, Beneficiary Eligibility Chapter

26
MSA 12-49 Disproportionate Share Hospital Process
(DSH)-Effective 11/01/2012
  • What is DSH? Monies from CMS that allows payment
    adjustments for hospitals that serve a
    disproportionate share of low income patients
    with special needs.
  • Beginning with Medicaid State Plan years 2011 and
    thereafter, the state is required to recover DSH
    payments made to a hospital in excess of its
    audited DSH ceiling. (States must verify their
    methodology for computing the calculations of
    hospital-specific DSH limits/payments to
    hospitals and annually report an independent
    certified audit of its DSH program as a condition
    for receiving Federal payments.)
  • Unless otherwise noted, the MDCH will modify its
    existing DSH process to mitigate DSH audit
    related recoveries. The new process will expand
    current DSH process to recalculate ceiling and
    payment amounts the year following the original
    calculation. This will allow hospitals to
    provide input into the DSH calculations by
    providing an opportunity to review ceiling and
    payment amounts, decline DSH funds, and reduce
    their DSH ceiling. This will establish a process
    to allocate audit related recovered DSH funds to
    remaining DSH eligible hospitals with capacity to
    accept DSH funds.

27
MSA 12-49
  • Purpose of the new process will expand MDCHs
    current DSH process to recalculate ceiling and
    payment amounts the year following the original
    calculation. The new process will allow input
    and opportunity to the involved providers. In
    addition this policy establishes a process to
    allocate audit-related recovered DSH funds to
    remaining DSH-eligible hospitals with capacity to
    accept additional funding.

28
MSA 12-51 Medicaid Liability-issued 11/01/2012
  • Bulletin clarifies existing policy regarding
    Medicaid Liability when patient has other
    coverage(s) through commercial or Medicare.
  • The MDCH will not pay for services denied by OI
    due to noncompliance with OI plans requirements.
    The provider and the beneficiary/responsible
    party have the responsibility for complying with
    OI plans requirements. In instances where MDCH
    has denied payment or made a post-payment
    recovery due to noncompliance it is the
    providers responsibility to remediate with the
    primary payer prior to re-billing MDCH.
  • Examples of noncompliance is failure to
  • Obtain a referral for the PCP
  • Be seen by a participating provider
  • Be seen in a participating place of service
  • Obtain 2nd opinion
  • Obtain PA

29
MSA 12-55-Medicaid Provider Screening/Enrollment
and Program Integrity -Issued 11/01/2012 and
effective immediately
  • As required by the Affordable Care Act the MDCH
    is implementing new Medicaid provider screening
    and enrollment requirements and new measures
    related to Medicaid fraud and abuse for the
    Medicaid FFS programs.

30
MSA 12-55
  • Providers will be categorized based on at least 3
    levels of risk. (This risk categorization is
    established by the CMS) High/Med/Low
  • Screening activities include
  • Fingerprinting/criminal background checks
  • Unannounced site visits
  • Verifications of SSN, NPI, OIG exclusion status
    and etc.

31
MSA 12-55
  • For hospitals probably the biggest issue will be
    that the ordering/referring/attending providers
    must be Medicaid enrolled. (prior to this the
    provider did not have to be enrolled in the
    CHAMPS-)
  • Initially the system will show information only
    edits to notify providers that the claim does not
    meet this standard criteria
  • Look for N253Missing/incomplete/invalid
    attending provider primary identifier.

32
MSA 12-55
  • Revalidation of Enrollment- All providers will be
    required to revalidate their Medicaid enrollment
    information a minimum of once every five years
    (or more often if requested by MDCH)
  • Providers must notify MDCH within 35 days of any
    change to their enrollment information.

33
MSA 12-59-Elective Delivery Prior to 39 Weeks
Completed Gestation-Effective 01/01/2013
  • Need to ensure that each Medicaid enrolled
    birthing hospital utilizes elective delivery
    evidence-based guidelines (EBGs)
  • Each Medicaid enrolled birthing hospital is
    required to submit MSA-1755 by 03/01/2013
  • This form certifies the hospital utilizes
    elective delivery EBGs for Medicaid
    beneficiaries and must be signed by the Chief
    Executive Officer and the Chief Medical Officer
    of the facility
  • Send to POB 30479 (Policy Division) or fax to 517
    335 5136

34
MSA 12-61-DRG Grouper Update-Effective 01/01/2013
  • DRG Grouper Version 30 will be used for
    In-Patient Hospital claims effective 01/01/2013
  • Hospital prices for medical/surgical hospitals
    reimbursed by DRG and Rehabilitation per diem
    rates have also been updated
  • Budget Neutral
  • Effective with admissions that occur on/after
    01/01/2013 reimbursement will be based on
    rates/grouper version in effect no the patients
    date of discharge.
  • Effective with this change the coding on the
    claim should be valid codes based on the date of
    discharge. In addition the patient age at the
    time of admission will continue to determine
    instances when system is grouping differentiated
    by age. (some alternate weight assignments)

35
MSA 12-62-OPPS Reduction Factor Effective
01/01/2013
  • Announces reduction factor for reimbursements
    made for Outpatient Prospective Payment System
    claims incurred on dates of service beginning
    with 01/01/2013
  • Budget-neutral
  • 54.3 (2012 DOS55.3)

36
MSA 12-65- Claim Predictive Modeling-Effective
01/01/2013
  • Claim Predictive Modeling. This new process
    will utilize statistical analysis models to
    identify and flag Medicaid claims in which there
    are billing irregularities. Any claim that has
    been flagged for review will suspend. The review
    may include a review of medical records and/or
    past claims. Providers must submit the requested
    records in a timely manner to avoid denials for
    lack of documentation. (Will be similar to the
    Fraud Prevention System screening implemented by
    CMS)
  • Look for CARC 133/RARC N10
  • CARC 133The disposition of the claim/service is
    pending further review
  • RARC N10Payment based on the finding of a review
    organization/professional consult/manual
    adjudication/medical or dental advisor.

37
MSA 12-67- ICD-10 Update-Issued 12/01/2012
  • ICD-10 implementation 10/01/2014
  • Medical Services Administration is continuing to
    promote awareness among provider community
  • ICD-10 implementation education as part of the
    core Medicaid educational training sessions and
    one-on-one provider consultations.
  • Informative ICD-10 webcasts, such as ICD-10
    Implementation "Get Ready", which is available
    on the MDCH website at www.michigan.gov/5010icd10.
    Additional webcasts will be available in the
    future, including ICD-10 Clinical Documentation.
  • State-wide ICD-10 implementation sessions.
    Providers should check the MDCH website regularly
    at
  • www.michigan.gov/medicaidproviders
  • (click the Medicaid Provider Training
    Sessions button in Hot Topics).

38
MSA 12-69-Post-Payment Review Hospital Audit
Contract-Issued 12/28/2012
  • This is announcing that the departments contract
    with the MPRO will be expiring and to expect a
    possible new contactor to be announced via an
    L-Letter once the post-payment review hospital
    audit contract has been granted.
  • L-12-46-the numbered letter was sent out and
    announces the contract was awarded to HMS.
    (Medicaid Recovery Audit Contract or RAC)
  • IMPORTANT NOTE MPRO will continue to provide
    the service of issuing the Prior Authorization
    Certification Evaluation Review or PACER.

39
MSA 12-70-HCPCS Code Updates- Issued 12/28/2012
  • This bulletin details for providers the procedure
    codes being adopted by MDCH for dates of service
    on and after 01/01/2013.
  • Any new procedure code not listed will not be
    covered.
  • For OPPS there is a list of new codes to be added
    to the Wrap Around Codes list.

40
MSA 12-70
  • The Wrap Around Codes(WAC) lists codes that
    MDCH will cover differently then OPPS. Example
    The status indicator on the addendum B may show a
    code is payable but on the WAC list it will show
    the code is not covered.
  • New quarterly WAC list has not yet been posted on
    our web-site (to the provider specific
    information pages.)
  • Remember that for some period of time we will
    still be using the APC software of the last
    quarter to process claims and this may cause some
    claim rejects. As a courtesy we always resurrect
    these claims once the next quarters software is
    loaded. Example A procedure code that has only
    become effective as of 01/01/2013 the may make
    the claim set A8 as the software will not
    recognize new codes.

41
Notices of Proposed Policy
  • All of our policy may be accessed on our
    web-site www.Michigan.Gov/MedicaidProviders
  • gtgtPolicy and Forms
  • From this page you find the Medicaid Provider
    Manual, Approved Policy Bulletins dating back to
    2001, and Michigan Medicaid Proposed Policy

42
Proposed Policy-how to be heard!
  • gtgtProposed Medicaid Changes
  • These documents inform interested parties of
    proposed changes in Michigan Medicaid policy.
    Proposed new policy and changes to existing
    policy must undergo a 30-day public comment
    period before it becomes final.
  • The page will explain the Comment Due Date, the
    project number and subject. Within the project
    number paper is the contact information to use
    for your comment.

43
Proposed Policy-cont.
  • Also out for comment is Notice1241-MHP
    Post-Stabilization Authorization Determinations
  • This will be issued to the Medicaid Health Plans
    and Hospitals to clarify responsibilities prior
    to any treatment and after stabilization. This
    post-stabilization authorization determination
    refers to the process in which inpatient hospital
    admission or admission to observation status is
    authorized by the MHP after the beneficiary has
    been stabilized.
  • Hospitals are required to make and document all
    of these requests via phone to the MHP prior to
    providing any treatment after stabilization. The
    MHP is required to response within in one hour of
    receipt of the call. The MHP contract requires
    the MHPs to provide 24/7 availability for
    requests. Hospitals may not wait until the next
    business day after stabilization to call for
    authorization.

44
CHAMPS PAYMENT SCHEDULE
  • The fiscal year 2013 schedule is now posted to
    our website.
  • Any claims submitted within 12 hours prior to a
    deadline may be subject to delay in the event of
    excessive system traffic!
  • Includes Electronic DEG Batch 837 cut-off
    times/dates
  • Includes Direct Data Entry cut-off times/dates

45
CHAMPS-Changes for Providers
  • Beginning in mid-December when providers use the
    inquiry screens they can pull up all of the
    claims that are both In Process and
    Suspended. These are essentially the same
    thing-an edit has triggered the claim to be
    manually reviewed.
  • When in the CHAMPS you will notice a LINKS box
    in the upper right far corner with new optional
    connections to other websites such as a link to
    our MDCH-Medicaid Hot Topics page!

46
Emergency Release and MASS Claim
Adjustments-Hospital
47
MASS Claim Adjustments
  • RA 01/24/2013 PC 04 OPH secondary claims
    overpaid more then the Medicare Co-Insurance (TBD
    TCNs) The claim notes will show 75520268
    overpayments to adj.
  • RA 01/12/2013 PC 02Additional batches of Oct.
    APC Updates-OPH to be Adjusted (2689 TCNs)
  • RA 12/27/2012 PC 52 Duplicate suspending
    claims-script deny(1,395 TCNs)
  • RA 12/20/2012 PC 51 OPH claims incorrectly
    limiting to charges to Adjust (5,191 TCNs)
  • Ra 11/29/2012 PC 48 MIP Indicator Fixes (3786
    TCNs)
  • Ra 11/29/2012 PC 48TPL VOIDS-no OI reported but
    patient over age 65 (TBD TCNs)
  • RA 10/18/2012 PC 42OPH crossovers with
    professional fees/revenue codes
    (1,000TCNs)-these are VOIDS (from CAH provider
    type)
  • Ra 09/27/2012 PC 39TPL VOIDS-no OI reported but
    patient over age 65 (8,782 TCNs)

48
Suspended Claims Activity
49
Suspended Claims
  • Claims processing is happy to inform providers
    that they are caught up!
  • Because of this be sure to send your
    documentation 5-10 days prior to sending in your
    claims. EZ LINK documentation filing is a manual
    process.

50
Suspended Claims
  • Top 3 edits to make claims suspend are
  • 1. Time limit
  • 2. Procedure code is not supported by the
    primary diagnosis
  • 3. No PACER on the claim

51
Suspended Claims
  • TIME LIMIT claims processing uses a specific set
    of filters to look for activity
  • Beneficiary ID
  • NPI
  • Date of Service
  • It is the providers responsibility to keep track
    of all TCNs involved and to supply them when
    necessary to satisfy time limit requirements

52
Suspended Claims
  • HCPCS compared to the Primary Diagnosis Code
    CARC 11 with N10Procedure code not allowed for
    primary DX.
  • Claims processing will manually review all
    diagnosis codes listed on the claim to verify if
    there is a proper support code. Documentation
    may actually be required if claim is not properly
    coded.
  • Several high dollar drug codes have recently been
    added to this editing group. (gt70 codes)
  • Some additional x-ray codes have also been added.
    (gt40 codes)

53
Suspended Claims
  • PACER not on the claim
  • Claims processing will look for claim
    notes/remarks
  • Claims processing may look for Occurrence Span
    Code 71 with the from/through dates of a prior
    In-Patient Hospital Stay
  • Transferring hospital should report appropriate
    patient discharge status code (02)
  • Receiving hospital must report appropriate Point
    of Origin for Admission (Form Locator 15)
  • And PACER number in the PRO Number Field
  • And Occurrence Span Code 71 with dates
  • Call Provider Support 800 292 2550 for billing
    information when your remittance advice denies
    claim with remark code N47-(Claim conflicts with
    another inpatient stay) and ask for other
    facility name and their from through dates.
    Investigate if PACER was or should be obtained
    etc.

54
Questions ?
  • CALL our hotline staff at 800-292-2550 Mon-Fri
    8-5.
  • You will always need to provide identifying
    information such as your name, your contact phone
    number(if we have to call you back) providers
    name, NPI and tax ID. We prefer that you call
    prepared with your TCN and all accompanying
    remittance advice with your questions.

55
Contact us
  • E-MAIL
  • You may also address any questions in writing to
    our staff that answers e-mail at
    ProviderSupport_at_Michigan.gov
  • WRITTEN inquiries
  • Provider Research Analysis
  • PO BOX 30731
  • Lansing, MI 48909

56
THANK YOU FOR PARTICIPATING IN THE MICHIGAN
MEDICAID PROGRAM
  • WINTER 2012/2013 REIMBURSEMENT UPDATES
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