• The Centers for Medicare and Medicaid Services (CMS) issued MLN Matters bulletin MM6786.  The bulletin advised providers that a new national coverage determination was issued stating that screening for HIV infection is reasonable and necessary for early detection of HIV and is appropriate for beneficiaries entitled to Part A and Part B.  Implementation is set for July 6, 2010, but was effective with claims from December 8, 2009.  Paid claims with dates of service on or after December 8, 2009 through July 6, 2010 will not be adjusted automatically.  Adjustment requests are required.  Please call 973-872-1497 for a copy of the bulletin.

• Highmark Medicare Services issued an alert email to all members on their mailing list advising that electronic Part B claims transmitted with an E principle diagnosis code will not cross over to the secondary payer.

• Highmark Medicare Services issued an alert email to all list serve members advising of a new Medicare Secondary Payer edit.  Effective July 6, 2010, new Medicare MSP Edit code M433 will validate that the other payer approved amount field is greater than or equal to the other payer paid amount when both values are submitted on electronic claims.  Edit M433 will be informational for 30 days as of July 6, 2010 on the MCS (Medicare Carrier System) Edit Report.  Effective August 6, 2010, this edit will result in a rejection of the MCS Edit Report.

• Highmark Medicare Services Part A April 2010 Newsletter advises providers of correct information to include when submitting MSP adjustments.  If an MSP claim rejects due to an open segment for Worker’s Compensation, Liability or No Fault, yet the claim reports an unrelated diagnosis code, and electronic adjustment can be submitted with the remarks “Not related to open segment” or “Medicare Prime”.    

• Cardiac rehabilitation claims for March 2010 service dates were not processed by Highmark.  The claims were returned to providers with reason code 32352.  The issue began on April 9, 2010.  Cardiac rehabilitation claims for April 2010 service dates have processed.

• On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.”  One of the provisions of this law clarifies Medicare’s policy for payment of services provided in hospital outpatient departments on either the day of or during the three days prior to an inpatient admission.  The provision is effective for services furnished on or after June 25, 2010.  Please call 973-872-1497 for a copy.

·         The activation of Edit 02067 – Attending Provider not Linked to Billing Provider that was originally scheduled to be implemented on June 3, 2010 is being delayed until July 8, 2010.  There are a significant number of affected providers that have not completed registration of their affiliated practioners. 

·         Claims submitted to New York Medicaid electronically on or after June 24, 2010, must contain a valid over 90 day indicator.  The new over 90 day indicators only impact outpatient claims.  Please call 973-872-1497 for the listing of new delay reasons.