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RA Banner Announcements
 
Banner Effective DateProvidersBanner Page Announcement
04/20/2018-04/27/2018Attention Select ProvidersAttention Select Providers. PCMH REPROCESS: Providers enrolled in the Person-Centered Medical Home Initiative (PCMH) were enrolled with retroactive effective dates, or were approved for changes in PCMH level or site address with retroactive effective dates. Claims which processed prior to the completion of the provider's PCMH enrollment or level/site address change were not paid with the PCMH differential payment rate and have now been reprocessed to include that amount. For any providers with retroactive site terminations, claims which processed with the PCMH differential payment rate have now been reprocessed without that amount. The impacted claims have been identified and reprocessed and will appear on your April 24, 2018 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 55.
04/20/2018-04/27/2018Attention Select ProvidersAttention Select Providers. FTC/POS 19 CLAIMS REPROCESSING FINANCIAL IMPACT: DXC Technology identified and reprocessed claims with dates of service January 1, 2016 and forward, where the systematic logic that prices details eligible under the HUSKY Health Primary Care Increased Payments Policy did not appropriately reimburse at the facility rate when Facility Type Code (FTC)/Place of Service (POS) 19 was reported at the detail. As a result, claims eligible under the HUSKY Health Primary Care Increased Payments Policy billed with FTC/POS 19 were, in error, reimbursed at the non-facility rate. Claims with dates of service prior to January 1, 2016, where FTC/POS 19 was reported on the detail prior to its effective date, were recouped. The impacted claims were adjusted and appeared on your December 12, 2017 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52. To lessen the financial impact of the reprocessing on providers, the Department of Social Services (DSS) decided to recoup the funds in increments of 20% over several claims processing cycles starting with the December 12, 2017 cycle. The last 20% of the outstanding Accounts Receivable (A/R) is being recouped in the current cycle. Providers will see the A/R posted under the "Financial Transactions" section of the April 24, 2018 RA.
04/20/2018-04/27/2018Attention Select ProvidersAttention Select Providers. FTC/POS 19 CLAIMS REPROCESSING FINANCIAL IMPACT: DXC Technology identified and reprocessed claims with dates of service January 1, 2016 and forward, where the systematic logic that prices details eligible under the HUSKY Health Primary Care Increased Payments Policy did not appropriately reimburse at the facility rate when Facility Type Code (FTC)/Place of Service (POS) 19 was reported at the detail. As a result, claims eligible under the HUSKY Health Primary Care Increased Payments Policy billed with FTC/POS 19 were, in error, reimbursed at the non-facility rate. Claims with dates of service prior to January 1, 2016, where FTC/POS 19 was reported on the detail prior to its effective date, were recouped. The impacted claims were adjusted and appeared on your December 12, 2017 Remittance Advice (RA) with an Internal Control Number (ICN) beginning with region code 52. To lessen the financial impact of the reprocessing on providers, the Department of Social Services (DSS) decided to recoup the funds in increments of 10% over several claims processing cycles starting with the December 12, 2017 cycle. 10% of the outstanding Accounts Receivable (A/R) is being recouped in the current cycle and the remaining 40% will be recouped in increments of 10% of the A/R amount due over the course of the next payment cycle or until the amount is satisfied. Providers will see the A/R posted under the "Financial Transactions" section of the April 24, 2018 RA.
04/20/2018-04/27/2018Attention Select Skilled Nursing FacilitiesAttention Select Skilled Nursing Facilities. RECOUPMENT TRANSACTIONS: The Department of Social Services (DSS) has completed a Centers for Medicare & Medicaid Services (CMS) financial transaction settlement in the April 20, 2018 claims cycle. The recoupments are related to a Skilled Nursing Facility settlement with CMS and will appear on your April 24, 2018 Remittance Advice (RA) under Accounts Receivable with reason code 8407 "CMS Settlement".
04/20/2018-04/27/2018Attention Select Home Health ProvidersAttention Select Home Health Providers. RECOUPMENT TRANSACTIONS: The Department of Social Services (DSS) has completed a Centers for Medicare & Medicaid Services (CMS) financial transaction settlement in the April 20, 2018 claims cycle. The recoupments are related to a Home Health settlement with CMS and will appear on your April 24, 2018 Remittance Advice (RA) under Accounts Receivable with reason code 8407 "CMS Settlement".


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