03/04/2019

Medicaid

Recent Oncology Related Issues and News

PENDING MEDICAID ISSUES - 

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 is brining together traditional Medicaid, some managed Medicaid plans and the Medicaid Contract Managers at the Spring Reimbursement Meeting to help explain and address the disparities.  Be sure to attend the Spring Reimbursement Meeting on April 17th!

Most Recent Bulletins That May Affect Medical Oncology

March 1, 2019 - MSA 19-07 - Updates to the Medicaid Provider Manual; Healthy Michigan Plan Changes; Retroactive Coverage of Existing Codes; Clarification to Bulletin MSA 19-01

CLICK HERE  to review all MSA Bulletins

Most Recent Announcements That May Affect Medical Oncology

February 27, 2019: Inpatient Hospital Providers FFS and Managed Care Duplicate Payments

February 27, 2019: Attention Inpatient Hospital Providers: MDHHS has identified claims with dates of service for years 2017 and 2018 that were paid by both Fee For Service Medicaid (FFS MA) and the Managed Care plan in error. These claims will have the FFS MA payment recouped through the claim void process. These claims can be identified by the claim note “Encounter MHP and FFS MA duplicate payment takeback”.

MDHHS will continue to monitor for duplicate payments made by FFS MA and MC plans for future dates of service and initiate claim voids every 6 months.

February 27, 2019: Update to Claims for Medicaid Beneficiaries Eligible for Medicare but not enrolled

February 27, 2019: Attention All Providers: This is an update to the Provider Alert issued on January 2, 2019: Claims for Medicaid Beneficiaries Eligible for Medicare but not enrolled. MDHHS has identified an internal issue that is causing claims that should be paid based on MSA Policy 18-50 to deny with claim adjustment reason code (CARC) 22. MDHHS is working on a permanent resolution in the interim there will be weekly reports ran to identify and reprocess these claims. Please allow 30 days from the date of submission for the claim to be resurrected prior to contacting provider support.

February 20, 2019: Outpatient Hospital Providers: October 2018 Quarterly APC & ASC software

February 20, 2019: Outpatient Hospital Providers: October 2018 Quarterly APC & ASC software: This is a notification that the October 2018 Quarterly APC & ASC software, were loaded into the CHAMPS system December 14, 2018. MDHHS has begun adjusting and resurrecting claims that were paid under the previous quarter’s software. If claims are not captured through the resurrect process providers are encouraged to adjust or rebill for correct processing.

To visit the Biller "B" Aware website CLICK HERE