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UB04 Update
Effective October 1, 2007
Admit Source now called "Point of Origin" REQUIRED on all IP admissions and OP Medicare diagnostic testing services.
Point of Origin:
Deleted codes 3; Nursery codes 1,2,3,4
New codes E, F; Nursery codes 5, 6
Effective January 1, 2008
Revenue codes:
Deleted codes 0599,0709,0719,0479
0759,0779,0789,0799
New codes 0948
CPT Modifiers
Retired codes QR,QV,QA
New codes Q0, Q1
FL 39-41 Value Code:
New code G8 Facility where IP Hospice Service
is Delivered
FL 43 NDC Reporting for Medicaid Drug Rebates:
11 character requirement
Effective April 1, 2008
FL 17 Discharge Statuses:
New code 70
Modified description code 05
FL 39-41 Value Code:
New code D4 Clinical Trial registry number
Effective July 1, 2008
FL 39-41 Value Codes:
New code FC Patient Paid Amount
New Code FD Credit received from
Manufacturer for a Replaced Medical Device |
| PacifiCare violations could cost insurer up to $1.3 billion
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| United Healthcare acquired PacifiCare in 2005 could face up to $1.3 billion in fines related more than 130,000 alleged claims-handling violations.
The company's alleged claims infractions include, but are not limited to, wrongful denial of covered claims, incorrect payment of claims, lost documents, failure to acknowledge receipt of claims in a timely manner and failure to manage provider network contracts and resolve provider disputes. The California Department of Insurance in working with the California Department of Managed Health Care said it directed a self-audit of PacifiCare's "unfair pre-existing condition denials," which resulted in $765,157.00 in claims and recoveries for consumers and providers. As a result of the entire investigation, more than $1 million has already been recovered for California consumers and providers.
In September 2007, United Healthcare said it reached an agreement with 36 states, to resolve all regulatory matters prior to August 27, 2007. It also said the company would self-report quarterly and annually, how it performs on a set of national performance standards. |
| Medicare NPI Update
March 1, 2008
All 837P and CMS-1500 claims must have an NPI or NPI/legacy pair in the required primary provider fields. Failure to include an NPI will cause the claim to reject.
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May 23, 2008
ONLY NPI's are to be reported in the primary provider fields on both 1500 and UB04 claims, effective May 23, 2008. The effective date refers to Date of Claim Receipt. After this date, if you report a Provider Legacy Identifier on a 1500 or a UB04 claim, your contractors will return them as unprocessed. Contractors have been instructed to return claims without appeal rights, which contain legacy provider identifiers, e.g. PIN's, UPIN's or National Supplier Clearinghouse numbers. Contractors shall not return claims in certain situations where an NPI is not required (e.g., foreign claims, deceased provider claims, other situations as allowed by CMS in the future) and legacy numbers are reported on the claim.
Failure to include an NPI will cause the claim to reject. If you cannot locate the NPI from the ordering, referring,attending,operating, other, service facility provider, or purchased service provider requires that the provider who is furnishing the service report their own name and NPI in the claim's ordering/referring/attending/operating/other service facility provider/purchased service provider fields.
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Join us and share in the levels of satisfaction our customers enjoy every day. Call today (925)685-9300.
Sincerely,
Jayne Kroner
Business Development
Cirius Group, Inc.
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| POA Indicator |
| April 1, 2008 Medicare will return claims to non-exempt hospitals if the POA code is not reported with each exempt diagnosis. Non-exempt hospitals will have to supply the correct POA code and resubmit the claims. POA will help determine DRG assignments. Blank POA indicator fields are unacceptable. Acceptable POA indicator codes are Y,N,U,W or 1.
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| Welcome New Customers |
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Methodist of Southern California
Shannon Medical Center
St. Joseph's/Candler
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| Customers Speak |
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"We just recently implemented Cirius Group solutions and in my opinion they are the best out there. I have experience using other claim scrubbers and Cirius is just a much better product. The fees up front are more, but it pays for itself in 6-12 months and you don't pay monthly fees forever. "
Debbie Blankenship
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| Cirius Events |
| Please look for us at your local education event. Picture reflects HFMA Region 11 event in Las Vegas proved to be a good time for all participants. | | |
