Copayments Being Taken on Services Rendered to Pregnant Women
HFS System Issue:
Copayments were being taken on services rendered to pregnant women.
Pregnant women are exempt from cost sharing. However, providers were having their payments reduced for a copayment on services rendered to pregnant women.
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.