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Elizabeth M. Whitehorn, Director

Liletta and Mirena Products Resolution

HFS System Issue:

Effective 4/1/15, HCPCS J7302 was used to bill Liletta and Mirena products.  Since the items have different reimbursement rates, the code was hand-priced through dates of service 12/31/15.  The two IUDs now have separate HCPCS codes, and they no longer need to be hand-priced. 

Problem:

The products were hand-priced by the Department staff, but the system priced claims at $0.00.

Providers Impacted:

Federally Qualified Health Centers and Rural Health Clinics

Procedure Codes Impacted:

J7302

Problem Begin Date:

Claims with dates of service April 01, 2015 through December 31, 2015

Problem Fix Date:

February 24, 2016

Resolution for Impacted Claims:

In order to receive the correct payment amount, providers must submit a replacement claim. 

The Department will accept replacement transactions submitted through MEDI or via 837P files if submitted within 12 months from the original paid voucher date.  To replace a claim, enter Claim Frequency “7”.

Detailed instructions on how to replace a claim electronically can be found in the Chapter 300, 837P Companion Guide.