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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.