08/21/2018

Payer Issue Tracking Page

Last Updated 8/21/18

WPS MEDICARE

Problem: WPS is taking back payments on Treanda, J9033.  WPS stated; "There was a mass audit on the J9033 code.  Treanda has not been manufactured since 2016 and should not be billed after 2017."  MSHO has researched this and while it is true that Treanda discontinued manufacturing in 2016 and Bendeka, J9034, is considered the replacement product, Treanda, is still being distributed and some physicians have continued utilization since the expiration date is 8/31/19.

Reported: 7/17/18

Update 7/18/18: MSHO has requested that monies be returned and instead, allow a post-payment review to verify the drug utilized was billed correctly and the product was not expired,  MSHO stated; "taking the money back without looking at the documentation is unreasonable and unfair to the physicians."

RESOLVED 8/6/18: 

MEDICAID

Please see the Medicaid section of this newsletter for updates.

BCBSM

No BCBSM system problems reported at this time.

BCN

No BCN system problems reported at this time.

MEDICARE PLUS BLUE (MPB)

See separate article on MPB in this Reimbursement Bulletin

NOTE: If you have a payer issue that you believe is a system problem and you do not see it listed above, PLEASE report it to MSHO! 

To report, email the description of your issue, including the ICN Number, date of service, provider number and patient contract number to billing@msho.org.  Do not include the patient’s name.

REMINDER – MSHO’s role is to resolve payer issues that will/can impact all members; we do not address individual claim issues. Unique, patient specific issues should not be reported.