05/01/2018

Medicaid

Recent Oncology Related Issues and News

PENDING MEDICAID ISSUES - UPDATED 5/1/2018

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....

Update 5/1/18 - MSHO and Medicaid have set a call to discuss the best approach to address the outstanding issues.  This call will occur next week.

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.

Update 4/24/18 - The fee schedule has been updated with 96377.  This issue has been resolved.

Most Recent Bulletins That May Affect Medical Oncology

March 1, 2018 - MSA 18-02 - Updates to the Medicaid Provider Manual; MDHHS Wrap Around Code List Format Change

 CLICK HERE  to review all MSA Bulletins

April 13, 2018: Attention Outpatient Hospitals: The January 2018 Quarterly APC & ASC software was loaded into CHAMPS March 23, 2018, and MDHHS has begun to adjust and reprocess claims that were processed under the previous quarter’s software. Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@Michigan.gov. 

April 13, 2018: Attention Outpatient Hospital providers: Update to BBA posted January 18, 2018: The CHAMPS system was updated to fix claims that were being denied with claim adjustment reason code A8 that have services with status indicators K or G on Medicare’s addendum B and the supporting payable procedure is on MDHHS wrap-around list with an assigned MDHHS status indicator. Providers will see claims with dates of service 1/01/2018 adjudicate appropriately. There are some providers that will continue to see denials for claims with dates of service prior to January 1, 2018. MDHHS will contact those affected providers directly with additional information and is currently working to correct the system.  Providers with further questions can contact Provider Support by phone 1-800-292-2550 or email ProviderSupport@Michigan.gov.

April 4, 2018 & March 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 

To visit the Biller "B" Aware website CLICK HERE