HFSMedical ProvidersClaims Processing System IssuesCopayments Being Taken on Services Rendered to Pregnant Women

Copayments Being Taken on Services Rendered to Pregnant Women

HFS System Issue:

Copayments were being taken on services rendered to pregnant women.

Problem:

Pregnant women are exempt from cost sharing. However, providers were having their payments reduced for a copayment on services rendered to pregnant women.

Providers Impacted:

Physicians, Chiropractors, Podiatrists, Optometrists, Advance Practice Nurses, Federally Qualified Health Center (FQHC), Encounter Rate Clinic (ERC), Rural Health Clinic (RHC) and Hospitals

Procedure Codes Impacted:

Any procedure code eligible for a copayment.

Problem Begin Date:

July 16, 2012

Problem Fix Date:

April 29, 2014

Resolution for Impacted Claims:

Providers may submit a void & rebill or a replacement claim. The department will accept electronic transactions submitted through MEDI or via 837P files to void or replace a payable or pending-payable claim if submitted within 12 months from the original paid voucher date.

Replacement Claims – To replace a single service line or entire claim, enter Claim Frequency “7.” Detailed instructions on how to replace a claim electronically can be found in the Chapter 300, 837P Companion Guide. This method is preferred as it requires no manual override.

Void & Re-bill – This process involves two steps. The void portion may be completed electronically or on paper. Please refer only to step #1 for a void with no re-bill.

  1. To electronically void a single service line or an entire claim, enter Claim Frequency “8”. Detailed instructions on how to void a claim electronically can be found in the Chapter 300, 837P Companion Guide. A paper void may be completed by submitting a NIPS Adjustment Form HFS 2292, Instructions for which may be found in Chapter 100, Appendix 6.

  2. Following completion of the void, a new original claim must be submitted within 90 days of the void DCN and may require manual override. If manual override is required, attach to a paper claim: a cover letter stating the reason for request for timely filing override.


Claims Processing System Issues

 

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