10/02/2018

Payer Issue Tracking Page

Last Updated 10/2/18

WPS MEDICARE

No WPS Medicare system problems reported at this time.

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 below and the separate article on MPB in this Reimbursement Bulletin

Problem: 

MSHO member offices have reported issues with denials for Xgeva (denosumab) because they did not get a prior authorization.  The portal to request a PA does not include Xgeva.  When you enter the brand name, Xgeva, nothing comes up.  When you enter the generic name, denosumab, the only choice it gives you is Prolia, which is another form of the drug (different NDC, different approval by the FDA).  MSHO has requested the portal be updated to include both Prolia and Xgeva so PAs would not have to be manually called in.

Reported: 8/28/18

10/2/18 - MSHO NOTE:  Check your claim and reimbursement!   If your claims have not been reprocessed and paid, then you MUST contact MPB.  If you have any problems with obtaining reimbursement for your claims, please let us know via email at billing@msho.org.

9/8/18 - RESOLVED - (FROM MPB)

After resolving system defects, Medicare Plus BlueSM PPO will adjust the following, estimated quantities of claims over the weekend of Sept. 22, 2018:

130 Local claims
What happened: HCPCS procedure code J0897 denied in error (for authorization) when billed with NDC 55513073001.

We updated our system configuration. It now removes the authorization requirement from the code combination.

Impacts: 2018 claims processed between June 28 through Aug. 22.

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.