01/08/2019

Medicaid

Recent Oncology Related Issues and News

PENDING MEDICAID ISSUES - UPDATED 12/18/2018

Michigan Managed Medicaid Plan Medical Drug Benefit 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, keep them coming.  Examples are in the hands of Medicaid, we have had some progress.  Stay tuned....

Update:  MSHO has scheduled a meeting with Medicaid to discuss a new process for addressing claims issues with Managed Medicaid plans.  Watch for additional information soon...

ALERT FROM MDHHS

ATTENTION - All Providers,

MDHHS identified an issue with provider-initiated claim adjustments submitted December 14, 2018, through December 20, 2018, that caused claims and service lines to be denied as duplicates (CARC 18 and RARC N522). The issue has been resolved and MDHHS will begin to resurrect and adjust the impacted claims on the January 17, 2019 pay cycle date. The impacted claims can be identified with the claim note “Claim initially denied as duplicate due to system issue. Issue has been resolved and should process as appropriate.”

Not all provider-initiated claim adjustments with duplicate denials were incorrectly denied during this time, it is advised that providers use the CHAMPS claim limit listfunction to determine if their claim or service line was processed correctly or not.

Providers with further questions can contact provider support at Providersupport@Michigan.gov or 1-800-292-2550

Most Recent Bulletins That May Affect Medical Oncology

December 28, 2018 - MSA 18-51 - Medicaid Eligibility Asset Policy

CLICK HERE  to review all MSA Bulletins

Most Recent Announcements That May Affect Medical Oncology

January 4, 2019: ASR coverage loaded directly into CHAMPS TPL file

January 4, 2019: Attention ALL Providers: Effective January 7, 2019, coverage that is received from Administration Systems Research (ASR) will be loaded directly into the CHAMPS TPL Coverage File. MDHHS Third Party Liability (TPL) will no longer update these records unless changes are available in ASR’s web portal after the last load date of eligibility from the National Roster File.

Providers are asked to please contact ASR for any questions related to loaded coverage. Phone 1-800-968-2449 or web portal https://www.asrhealthbenefits.com.

January 2, 2019: Claims for Medicaid Beneficiaries Eligible for Medicare

January 2, 2019: Attention All Providers: Per MSA policy bulletin MSA 18-50 effective for dates of service on and after January 1, 2019 MDHHS will begin to pay claims for Medicaid beneficiaries who are eligible and NOT ENROLLED with Medicare, this includes beneficiaries that are only partially Medicare enrolled (i.e. enrolled in Medicare Part A and not Medicare Part B). The claims will be paid as Medicaid primary, once the beneficiary obtains Medicare coverage Medicare should be billed and the Medicaid claim should be adjusted by the provider to reflect the primary payer processing. If claim adjustments are not performed by providers, then MDHHS Third Party Liability (TPL) will initiate claim voids.

To visit the Biller "B" Aware website CLICK HERE