As of the January 2017 implementation of the Delaware Medical Assistance Program’s Healthcare Portal a few offices have not received EOBs or payment. If you have submitted Delaware Medicaid claims through Change Healthcare (Emdeon) and have not received an EOB, please read the attached Customer Service Alert.

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The deadline for Eligible Professionals (EPs) to submit Reconsideration forms for the 2017 payment adjustment—based on the 2015 EHR reporting period—is February 28, 2017. No applications will be accepted after the deadline. Please visit the CMS website to find the EP Reconsideration Application. Complete this application if you received a letter from CMS that said…

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New Policy on JW Modifier Effective January 1, 2017, the use of the JW modifier is required for claims with unused drugs or biologicals from single use vials or single use packages that are appropriately discarded. Providers are required to document the discarded drug or biological in the patient’s medical record. The JW modifier is…

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United HealthCare Community Plan- effective Nov 24, 2016. An EPSDT Visit coding is required for Early and Periodic Screen, Diagnostic and Treatment (EPSDT) Visits. This change is being done in order to become compliant with the State requirements. Claims will be denied if this information is not included when submitting claims for certain CPT and…

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If you have experienced your electronic secondary claims being denied on Emdeon Vision with the following message or one similar, you will need to start using Claim Adjustment Reason Codes going forward. Message: Service Line COB Information: Invalid; the sum of all Service Line Paid Amounts plus the Service Line Adjustment Amounts for each payer…

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To ease the transition to ICD-10, Medicare allowed certain flexibility when coding based on specificity.  Those flexibility exceptions will end as of October 1, 2016.  “ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of the ICD-10 code as long as there…

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Effective 01/01/2017, Capital BlueCross will discontinue their Trading Partner agreement with Change Healthcare.  Capital BlueCross will go from a participating to a non-participating insurance carrier status. There is no change to your office if you have transitioned to Change Healthcare’s Provider Complete.  For providers that are NOT submitting claims through Provider Complete, a charge of…

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