June 2004 Medicare Bulletin - North Carolina Insert

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Table of Contents

• Discontinuation of Requirement to Send Photographs and Visual Fields with Claims for Blepharoplasty
• North Carolina Health Professional Shortage Areas (HPSAs)
• North Carolina Medicare Part B Provider Relations Deapartment Announces a Process Change for Telephone and Written Inquiries
• Policy Updates

Discontinuation of Requirement to Send Photographs and Visual Fields with Claims for Blepharoplasty

Effective July 1, 2004, CIGNA Government Services Part B for North Carolina will eliminate the requirement for providers to submit visual field reports and photographs with each claim for blepharoplasty, ptosis, etc. This will not change the requirements, which will remain the same. These requirements are listed in NC LMRP 96-005 (CMS database # L5703), and may be accessed on the CMS or CIGNA Government Services Web sites. This also does not indicate that any cosmetic surgery will be covered. Cosmetic surgery remains non-covered by Medicare. Claims for these procedures should be submitted with the –KX modifier appended. Use of this modifier will indicate that the criteria have been met and the requisite documentation, including visual fields and photographs, are maintained in the medical record in the provider’s office and are available to Medicare should an audit be performed. If the required documentation is not in the record, these claims will be subject to retroactive denial with recoupment of monies.

(04-0835)

North Carolina Medicare Part B Provider Relations Department Announces a Process Change for Telephone and Written Inquiries

In order to conform to the Centers for Medicare and Medicaid Services (CMS) contractor requirments and metric standards, the North Carolina Provider Relations team will no longer respond to your telephone and written inquiries, effective May 1, 2004.

All calls received in Provider Relations on May 1, 2004 and after will be referred to the Customer Service Call Center for a customer service representative to handle. All telephone inquiries should be handled through the customer service call center by dialing 1.866.238.9651. You may also submit your question through the Online Help Center at http://www.cignamedicare.com/medicare_dynamic/customer_service/index.html. By following this protocol, we can ensure that your questions are accurately processed and answered in a timely manner.

All written inquiries should be mailed to the following address:
CIGNA Government Services
Attn:
P.O. Box 671
Nashville, TN 37202

Note: To expedite the handling of inquiries, place an attention line on the inquiry and on the envelope in conjunction with the address.

Below is a list of areas to which you may want to direct your telephone or written inquiry.

ACCOUNTING
Overpayment refunds, offsets, lost checks, etc., (other than MSP):

Mail Refund Checks (Personal Provider Checks):
CIGNA Government Services
Attn: Accounting Dept.
P.O. Box 10820
Newark, NJ 07193-0820

CIGNA Government Services checks that need to be returned to us:
CIGNA Government Services
Attn: Accounting Dept.
P.O. Box 671
Nashville, TN 37202

Personal Provider Checks for MSP overpayment refunds:
CIGNA Government Services
Attn: MSP
P.O. Box 10820
Newark, NJ 07193-0820

Note: Do not combine MSP refunds with other refunds!

APPEALS (Telephone Reviews/Written Reviews)
Telephone Review Hotline:
1.866.352.6695

Mailing Address (Written Reviews):
CIGNA Government Services
Attn: Appeals
P.O. Box 671
Nashville, TN 37202

Note: Redeterminations are the new first level of appeal under Section 521 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA).

CORRESPONDENCE
General inquiries, e.g. assignment; adjustments, underpayments-send to attention:

“Corrected Claim,” when incorrect info’ on original claim:
Mailing Address:
CIGNA Government Services
Attn: Correspondence
P.O. Box 671
Nashville, TN 37202

CUSTOMER SERVICE
Claims inquiries and claims status inquiries (IVR), duplicate Medicare Payment Reports, explanations of denials, general coverage questions, overpayment questions, MSP, etc.

1.866.238.9651

Information Needed:
Health Insurance Claim Number

• Patient Date of Birth
• Individual PIN Number
• Date of Service
• Procedure Code/Place of Service
  

EMC/EDI HELP DESK
Application for EDI features, changes to EDI provider records, questions about EDI transmissions, claim submissions, approved vendors, etc. 1.866.352.1608.

Mailing Address:
CIGNA Government Services
Attn: EDI
P.O. Box 671
Nashville, TN 37202

EMC/EDI TECHNICAL HELP DESK
EDI formats, ANSI requirements, testing, vendors’ technical issues, etc. 1.866.352.1608

Mailing Address:
CIGNA Government Services
Attn: EDI
P.O. Box 671
Nashville, TN 37202

FREEDOM OF INFORMATION
Any request for information not readily available to the public should be submitted in writing, giving your mailing address, phone number, and a legal signature.

Mailing Address for inquiries:
CIGNA Government Services
Attn: FOI
P.O. Box 671
Nashville, TN 37202

MEDICARE SECONDARY PAYER (MSP)
MSP claims, MSP overpayments, etc.

Mailing address for inquiries:
CIGNA Government Services
Attn: MSP
P.O. Box 671
Nashville, TN 37202

PROVIDER ENROLLMENT
Provider applications for PINs, changes to provider records, etc. (only questions relating to enrollment) 1.866.520.4007

Mailing Address:
CIGNA Government Services
Attn: Provider Enrollment
P.O. Box 25226
Nashville, TN 37202

GHI - MSP COORDINATION OF BENEFITS (COB) CONTRACTOR
1.800.999.1118

CERT OPERATIONS CENTER (AdvanceMed)
1.804.264.1778

(04-0867)

POLICY UPDATES

Blepharoplasty - Blepharoptosis Repair

(LMRP 96-005)
The following revision was made to the policy:
Removed requirement to submit photographs and visual fields with claim. Instead documentation must be maintained in medical record, and claim submitted with -KX modifier to indicate requirements met and documentation available.

(04-1007)

North Carolina Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY AREA NAME/PARTS RURAL/URBAN Alexander All Urban Anson All Rural Beaufort Bayboro - Aurora Richland Twp. Belhaven - Swan Quarter Bath Twp., Pantego Twp Rural Bertie All Rural Bladen5 All Rural Brunswick1 All Rural Caldwell Western Caldwell - Globe Twp., Johns River Twp., Mulberry Twp., Patterson Twp., Wilson Creek Twp., Rural Carteret5 Eastern Cateret - Atlantic Twp., Cedar Island Twp., Davis Twp., Harkers Islands Twp., Marshallberg Twp., Merrimon Twp., Portsmouth Twp., Sea Level Twp., Smyrna Twp., Stacy Twp., Strait Twp. Rural Caswell All Rural Cherokee3 Andrews Area, Valley Town Twp. Rural Clay All Rural Columbus All Rural Currituck All Urban Dare Hatteras - Ocracoke Hatteras Twp., Kinnakeet Twp., Rural Edgecombe All Urban Franklin All Urban Gates All Rural Graham All Rural Greene6 All Rural Guilford Inner City Greensboro - Census Tracts 101, 107.02, 108.01, 110, 111.01, 112, 113, 114, 115 Urban Harnett4 Western Harnett - Anderson Creek Twp., Barbecue Twp., Johnsonville Twp., Lillington Twp., Stewarts Creek Twp., Upper Little River Twp. Rural Hoke All Rural Hyde Belhaven-Swan Quarter Currituck Twp., Fairfield Twp., Lake Landing Twp., Lake Mattamuskeet Unorg., Swan Quarter Twp. Hatteras-Ocracoke Ocracoke Twp. Rural Lenoir East Kinston - Census Tracts 101-105, 107 Urban Macon5 Franklin - Burningtown Twp., Cartoogechaye Twp., Cowee Twp., Ellijay Twp., Flats Twp., Franklin Twp., Millshoal Twp., Nantahala Twp., Smiths Bridge Twp. Rural Mecklenburg Central Charlotte - Census Tracts 1, 4, 5, 6, 7, 8, 36, 37, 38.98, 39.01, 39.02, 41, 42, 45, 46, 47, 48, 49, 50, 51, 51.01, 52 Urban Montgomery5 All Rural Northampton All Rural Onslow1 All Urban Pamlico Bayboro - Aurora Rural Pender All Rural Person All Rural Randolph All Urban Robeson All Rural Stokes Danbury - Census Tracts 701, 702, and 703 Urban Tyrrell All Rural Warren2 All Rural Washington All Rural

¹ No longer classified as a HPSA, effective December 1, 1999.
² Classifed as a HPSA, effective March 1, 2001.
³ Classifed as a HPSA, effective July 1, 2001.
⁴ No longer classified as a HPSA, effective September 1, 2001.
⁵ No longer classified as a HPSA, effective August 1, 2002.
⁶ No longer classified as a HPSA, effective June 1, 2004.

(04-1008)