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Elizabeth M. Whitehorn, Director

D17 Quantity Billed Requires Prior Approval

HFS System Issue:

DME claims with a maximum quantity allowed within a specific timeframe denied D17, Quantity Billed Requires Prior Approval.

Problem:

On 9/11/2014, the system was changed to manage the quantities for a group of supplies. The change affected all DME codes with quantity limitations.

Providers Impacted:

Durable Medical Equipment and Supplies Providers

Procedure Codes Impacted:

All DME HCPC codes that are coded PA Req: N and the Max Quan/ Days field is populated on the fee schedule which can be viewed at http://www.illinois.gov/hfs/MedicalProviders/MedicaidReimbursement/Pages/DME.aspx

Problem Begin Date:

Claims received on or after 9/11/14.

Problem Fix Date:

10/1/14

Resolution for Impacted Claims:

Providers must rebill.