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Customer Service Frequently Asked Questions
North Carolina - Second Quarter 2005
- According to the December 2004 Medicare Bulletin, I should
use HCPCS code G0001 when billing for venipunctures. However, I received
denials for this code for my 2005 services. Why is code being denied
as invalid?
- Why are my claims being denied with Remark Code M73 for
the HPSA bonus?
- What are the new codes for drug administration and where
can I find the Medicare guidelines for these codes?
- Other than claim status, what other information be obtained
through the IVR system? Also, why do I have to use the IVR for claim
status?
- Why are my claims for Low Osmolar Contract Materials (LOCM)
being denied if the Local Coverage Determination Policy was retired
January 1, 2005?
- According to the December 2004 Medicare
Bulletin, I should use HCPCS code G0001 when billing for venipunctures.
However, I received denials for this code for my 2005 services. Why
is code being denied as invalid?
A. Effective January 1, 2005 , CMS replaced code G0001 with CPT code
36415. A MedLearn article was posted in November on the "What's
New" webpage. Also, the same article was printed in the January
2005 Medicare Bulletin in regards to the 2005 clinical laboratory services.
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- Why are my claims being denied with
Remark Code M73 for the HPSA bonus?
A. Effective January 1, 2005 , due to a provision of the MMA (Medicare
Modernization Act), Medicare has revised the process for paying HSPA
bonuses. This revision now authorizes payments for physician services
in PSAs (Physician Shortage Area). The PSA bonus payments will be based
on the zip code of the location of where the service is performed. Also, these
bonus payments are allowed for primary care providers (General Practice,
Family Practice, Internal Medicine, and Obstetrics/Gynecology) and
specialty care providers (all other physician provider specialties except
Dentists, Chiropractors, Podiatrists, and Optometrists). In order to
receive the bonus payment, the zip code in which the services are rendered,
must be on the listing of zip codes for that particular category. A complete
listing of zip codes eligible for the bonus payments in the HPSAs
or PSAs is on the CMS (Center for Medicare and Medicaid Services)
website at http://www.cms.hhs.gov/providers/bonuspayment/default.asp. An
article was published in the November 2004 Medicare Bulletin concerning
the HSPA and PSA bonus payments.
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- What are the new codes for drug administration
and where can I find the Medicare guidelines for these codes?
A. A MedLearn Matter article was published in the March 2005 Medicare
Bulletin titled "2005 Drug Administration Coding Revisions-MMA".
This informative article addresses the guidelines and new codes for the
following categories:
- Hydration;
- Therapeutic or diagnostic injections and intravenous infusions
other than hydration; and
- Chemotherapy administration.
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- Other than claim status, what other
information be obtained through the IVR system? Also, why do I have
to use the IVR for claim status?
A. Our Provider Contact Center is committed to providing the highest
level of customer service. With this in mind, the CMS has required the
provider community to use the IVR system to obtain claim status information.
By using the IVR system, this allows our Customer Service Representatives
to handle more complex inquires/issues.
Besides claim status, beneficiary eligibility, deductible status, outstanding
check amounts, allowable for procedure codes, and other information,
can be obtained through the IVR system. The IVR system is available before,
during, and after office hours. Instructions for using the IVR system
can be found on our website at: http://cignamedicare.com/partb/ivr/nc.html.
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- Why are my claims for Low Osmolar Contract
Materials (LOCM) being denied if the Local Coverage Determination Policy
was retired January 1, 2005 ?
A. Although our LCD for LOCM was retired January 1, 2005 , CIGNA Medicare
processes these type services according to the CMS guidelines for LOCMs
until further notice. These guidelines can be found on the CMS website
at http://www.cms.hhs.gov/manuals/cmsindex.asp (Pub
100-04, Chapter 13, Section 30.1).
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