Copayments Being Taken on Services Rendered to Pregnant Women
HFS System Issue:
Copayments were being taken on services rendered to pregnant women.
Problem:
Pregnant women are exempt from cost sharing. However, providers were having their payments reduced for a copayment on services rendered to pregnant women.
Providers Impacted:
Physicians, Chiropractors, Podiatrists, Optometrists, Advance Practice Nurses, Federally Qualified Health Center (FQHC), Encounter Rate Clinic (ERC), Rural Health Clinic (RHC) and Hospitals
Procedure Codes Impacted:
Any procedure code eligible for a copayment.
Problem Begin Date:
July 16, 2012
Problem Fix Date:
April 29, 2014
Resolution for Impacted Claims:
Providers may submit a void & rebill or a replacement claim. The department will accept electronic transactions submitted through MEDI or via 837P files to void or replace a payable or pending-payable claim if submitted within 12 months from the original paid voucher date.
Replacement Claims – To replace a single service line or entire claim, enter Claim Frequency “7.” Detailed instructions on how to replace a claim electronically can be found in the Chapter 300, 837P Companion Guide. This method is preferred as it requires no manual override.
Void & Re-bill – This process involves two steps. The void portion may be completed electronically or on paper. Please refer only to step #1 for a void with no re-bill.
To electronically void a single service line or an entire claim, enter Claim Frequency “8”. Detailed instructions on how to void a claim electronically can be found in the Chapter 300, 837P Companion Guide. A paper void may be completed by submitting a NIPS Adjustment Form HFS 2292, Instructions for which may be found in Chapter 100, Appendix 6.
Following completion of the void, a new original claim must be submitted within 90 days of the void DCN and may require manual override. If manual override is required, attach to a paper claim: a cover letter stating the reason for request for timely filing override.