MDHHS: Upcoming Voids for Prenatal or Preventive Pediatric Care Claims

The Centers for Medicare & Medicaid Services (CMS) has issued additional guidance regarding the Bipartisan Budget Act of 2018 which was signed into law February 9, 2018.

Previously, the law required that state Medicaid agencies make payments for prenatal or preventive pediatric care, including screening and diagnosis, within 30 days without regard to third party liability (TPL), and if a third party is found to be liable, seek reimbursement after payment is made. The updated Budget Act now requires that state Medicaid agencies collect information on TPL prior to making payments. Click here for CMS guidance.

CHAMPS will be updated on June 22 to begin editing these types of claims. Providers may see an increase in claim denials indicating the beneficiary has primary insurance.

In the future, Michigan Department of Health and Human Services (MDHHS) will void claims that have paid for the following HCPCS codes; 59000, 59001, 59412, 59425, 59426, 90707, 90710, 90713, 99381-99385, D1110, D1120, S0620 and S0621, reported no primary insurance and included a prenatal or preventive pediatric care diagnosis code.

Providers will need to bill the claim to the primary payer as outlined in MSA policy within the provider manual, Coordination of benefits Chapter, Section 1.3 Verification of Other Insurance. Once the claim has been processed by the primary payer providers can bill their claim to Medicaid reporting the primary payer information.

CMS bulletin: