HFSMedical ProvidersClaims Processing System IssuesAmbulance Rate Changes Update – Second Batch

Ambulance Rate Changes Update – Second Batch

Problem:

As a result of an administrative rule change, the reimbursement rates to ambulance providers were changed effective with dates of service 07/01/13. In addition, the SMART Act 2.7% reimbursement rate reduction no longer applies to ambulance services. Since the rule affected reimbursements already made to providers for dates of service back to 07/01/13, HFS has underpaid providers.

Providers Impacted:

Ambulance Service Providers

Procedure Codes Impacted:

A0422, A0425, A0426, A0427, A0428, A0429, A0431, A0431 (H), A0433, A0434

Problem Begin Date:

Claims with dates of service on or after 07/01/13

Problem Fix Date:

Claims received on and after April 9, 2014 for dates of service on or after 7/1/13

Resolution for Impacted Claims:

Approximately 300K claims with dates of service on or after July 1, 2013 will be adjusted as a result of the rate increase. The department is processing the adjustments in batches as some of the claims require additional review. The first batch of adjustments was submitted June 23, 2014.

The second batch of adjustments includes approximately 10K claims that were submitted on July 11, 2014. The second batch of adjustments includes the remaining claims billed under category of service 50 with procedure codes A0422, A0425, A0427, A0428, A0429, A0431, A0433, A0434.

In the process of researching which claims to adjust, some claims were found to be overpaid on mileage code, A0425. The department continues to research the problem. Two problems with processing claims have been identified:

The department continues to work through remaining claims with category of service 51. All providers should verify their mileage. Please continue to access this site for updated announcements.


Claims Processing System Issues

 

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