Provider enrollment relief for areas affected by hurricane Irma

  • Sep 28, 2017

Effective September 13, 2017, and remaining in effect for a period of 180 days, First Coast implemented provider enrollment relief for providers in Florida, U.S. Virgin Islands, and Puerto Rico. During this period, FCSO will: • Refrain from mailing any revalidation letters, including subsequent revalidation letters (i.e., payment hold and deactivation letters due to non-response to revalidation...

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The CAP Leads Coalition Urging Changes to Balance Billing Legislation

  • Sep 28, 2017

A coalition of physician groups, led by the CAP, is urging the National Conference of Insurance Legislators (NCOIL) to make significant changes to its draft Out-of-Network Balance Billing Transparency Act to ensure network adequacy and fair payment for out-of-network services. The National Conference of Insurance Legislators (NCOIL) is an organization of state legislators whose main area of...

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Allergen Specific IgE Testing Policy Updated

  • Sep 28, 2017

Effective for dates of service on or after October 1, 2017, when billing for CPT code 86003 (allergen specific IgE; quantitative or semiquantitative, each allergen) providers must include documentation in the recipient’s medical record with one of several newly established criteria. Claims billed with CPT code 86003 that do not have supporting medical documentation may result in recoupment....

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Medically Unlikely Edits Should Not Deny Claim Lines that Are Prior Authorized, CR 59426

  • Sep 28, 2017

An issue was discovered where some claim lines were being denied for “medically unlikely” when the claim had a prior authorization. This denial was an error. The system has been updated and affected claims will be reprocessed.  No provider action is needed.

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Transition to New Medicare Numbers and Cards

  • Sep 28, 2017

CMS, through the Medicare Administrative Contractors (MACs), recently mailed letters to all Medicare Fee-For-Service providers about their work to assign new numbers (known as Medicare Beneficiary Identifiers or MBIs) and issue new Medicare cards to all people with Medicare beginning in April 2018. Starting in June 2018, you can look up your patients’ new Medicare numbers through your MAC’s...

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Alpha Prefix Change

  • Sep 28, 2017

The three-character prefix, previously referred to as the "alpha prefix," is a foundational component of the BlueCard program. The information the prefix contains defines the service relationships and arrangements between the Blue Cross Blue Shield (BCBS) plan and its subscribers. To increase the prefix pool needed for BCBS plans, the prefix is being modified to allow numeric characters....

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Contract Award to Palmetto for A/B MAC Jurisdiction J Cahaba

  • Sep 28, 2017

On September 7, 2017, the Centers for Medicare & Medicaid Services (CMS) awarded Palmetto GBA a new contract for the administration of Medicare Part A and Part B Fee-for-Service (FFS) claims in the states of Alabama, Georgia, and Tennessee (A/B MAC Jurisdiction J). CMS will oversee the transfer of A/B MAC work from the incumbent contractor, Cahaba Government Benefit Administrators, LLC, to...

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Age Restriction and Gender Specification Updates for EWC Diagnosis Services

  • Sep 28, 2017

A NewsFlash article published in December 2016 announced the removal of age restrictions for Every Woman Counts (EWC) breast cancer diagnosis codes effective for dates of service on or after January 1, 2017. Additionally, effective retroactively for dates of service on or after January 1, 2017, in accordance with Assembly Bill 1795, EWC will provide breast diagnostic services to all symptomatic...

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