KNOWN ISSUE: Medicare Part B Claims Didn't Cross Over

Ashley M 7 years ago in Known Issues updated 7 years ago 0

NGS Medicare has sent an email to all subscribed providers. For your convenience, this notice is below:

What Happened: 
National Government Services (NGS) is informing Part B providers of an issue involving claims that did not successfully crossover to the supplemental carrier. Provider remittance advice (RA) indicated in error that claims had automatically crossed over to the supplemental insurance carrier. Letters were later issued advising that claims could not be sent to the supplemental carrier due to the reported ICD-10 diagnosis code being truncated.
The codes are not truncated at this current date of service.
Why It Happened:
The issue occurred because the Benefits Coordination & Recovery Center (BCRC) edit validator may have installed “higher level of specificity” ICD-10 diagnosis codes a few weeks before 10/1/2017. The BCRC consolidates the activities that support the collection, management and reporting of other insurance coverage for Medicare beneficiaries. The purpose of the coordination of benefits (COB) program is to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken Medicare payments. The BCRC coordinates with the Medicare Administrative Contractors (MACs) in crossing claims over to the supplemental insurers.
What This Means to You:
If you received one of these letters advising you the claim was not crossed over to the supplemental insurer, you will need to submit the claim directly to the secondary insurer. With the 2018 ICD-10 upgrade, the new diagnosis codes will go into effect on date of service 10/1/2017. Please be aware the changes to ICD-10 that may affect your practice.

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