03/20/2018

Medicaid

Recent Oncology Related Issues and News

PENDING MEDICAID ISSUES - UPDATED 3/20/2018

We Need Your Help To Address Michigan Managed Medicaid Plan Medical Benefit Drug Restrictions

MSHO continues to address the disparity in drug approvals between traditional Medicaid and the managed Medicaid plans. The managed plans are required to approve therapies that are a medical benefit with traditional Medicaid.  Thank you to those that sent in examples.  Those examples are in the hands of Medicaid and we are awaiting the next steps.  Stay tuned....

Issue:  CPT 96377 not being reimbursed by traditional and some managed Medicaid plans

Update 3/12/18 - Medicaid is aware.  They do not have 96377 loaded into their system.  In the interim MSHO has been advised to utilize the 96372 just as we did for Medicare & Medicaid in 2017.  They expect to have the 96377 loaded beginning 2nd quarter, April 1, 2018.

Most Recent Bulletins That May Affect Medical Oncology

January 30, 2018  - MSA 18-02  -  Update to the Coverage of Physician-Administered Drugs and Biological Products

January 30, 2018  - MSA 18-01  -  Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

 CLICK HERE  to review all MSA Bulletins

March 15, 2018: Attention ALL Providers: The File Transfer Service (FTS) portal will be unavailable on Sunday, March 18, 2018, from 6:00 AM EST to noon EST for maintenance. Please refrain from submitting files during this maintenance period. We apologize for any inconvenience this may cause. 

Please contact AutomatedBilling@Michigan.gov  if you require further assistance.

March 7, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) Provider Support is in the process of upgrading our Call Center experience. Over the next couple of weeks, you may experience higher than normal wait times and slower response times.  We apologize for any inconvenience and frustration this may cause during our transition, but we are confident this upgrade will lead to shorter hold durations and an overall better customer service experience. While we will continue to do our best to answer all calls coming in, we would like to remind providers that the option to email ProviderSupport@Michigan.gov  with your inquiries still exists. MDHHS will send an update to this notice when the upgrade has been completed.

March 7, 2018 & February 7, 2018: Attention ALL Providers: The Centers for Medicare & Medicaid Services (CMS) will remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new unique Medicare Beneficiary Identifier (MBI) will replace the current Health Insurance Claim Number (HICN) on the new Medicare cards. CMS will begin mailing new cards to people in April 2018.

Providers systems and business processes must be ready to accept the new MBI number by April 2018 for transactions, such as billing, claim status, eligibility status, and interactions, with the CMS Medicare Administrative Contractor (MAC) contact centers.

There will be a transition period when providers can use either the HICN or the MBI to exchange data and information with CMS. The transition period will start April 1, 2018, and run through December 31, 2019. However, providers systems must be ready to accept the new MBI by April 1, 2018.

Providers should refer to the CMS Fact Sheet to ensure they are prepared to receive the MBI: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TransitiontoNewMedicareNumbersandCards-909365.pdf

Learn more about the CMS New Medicare Card Project: https://www.cms.gov/medicare/new-medicare-card/nmc-home.html

March 6, 2018: Attention ALL Providers: To better provide you with the information you need, Michigan Department of Health and Human Services (MDHHS) have created a new Provider Enrollment (PE) webpage. Access the new webpage by using the link below. If you have the previous webpage bookmarked you will need to re-link to the new page.

Provider Enrollment webpage: http://www.michigan.gov/mdhhs/0,5885,7-339-71551_2945_42542_42543_42546_85441---,00.html

If you have any questions, please email ProviderOutreach@Michigan.gov

To visit the Biller "B" Aware website CLICK HERE