04/02/2019

Medicaid

Recent Oncology Related Issues and News

PENDING MEDICAID ISSUES - 

Molina Medicaid

Problem:  Imfinzi, J9999 for dates of service in 2018 not being recognized.

Reported 3/8/19

UHC Community Plan

Problem: Velcade (J9041) not paid from July through December 2018.

Reported 2/6/19

Update: 3/29/19 - UHC is aware of the issue, they are correcting configuration of their system and will reprocess outstanding claims.

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!

The updated Affordable Care Act Federal upper limits (FUL) calculated in accordance with the Medicaid Covered Outpatient Drug final rule with comment are now available on the Medicaid.gov website. States will have up to 30 days from the April 1, 2019  effective date to implement these updated FULs.  

For further information on the FUL program, please see the Federal Upper Limits page. CLICK HERE

Most Recent Bulletins That May Affect Medical Oncology

April 1, 2019 - MSA 19-05 - Non-Taxable Annuity Income for Modified Adjusted Gross Income (MAGI)-Based Medicaid Programs

CLICK HERE  to review all MSA Bulletins

Most Recent Announcements That May Affect Medical Oncology

March 28, 2019: Outpatient Hospital Providers: January 2019 Quarterly APC & ASC Software

March 28, 2019: Outpatient Hospital Providers: January 2019 Quarterly APC & ASC software: This is notification that the January 2019 Quarterly APC & ASC software, was loaded into the CHAMPS system March 22, 2019. 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.

March 18, 2019: United Healthcare Coverage

March 18, 2019: Attention ALL Providers: Effective April 1,2019, commercial coverage that is received from United Healthcare, United Medical Resources (UMR), Golden Rule Insurance, Sierra Health & Life Insurance, and Oxford Health Plan will be loaded directly into the CHAMPS TPL Coverage File. MDHHS Third Party Liability (TPL) will no longer update these TPL records unless changes are available in one of United Healthcare’s web portals after the last load date of eligibility from the National Roster File. Providers are asked to please contact United Healthcare for any questions related to loaded coverage.

To visit the Biller "B" Aware website CLICK HERE