Skip to Main Content

Breadcrumb

  1. HFS
  2. Medical Providers
  3. Claims Processing System Issues
  4. Copayments Were Being Applied Incorrectly for the New ACA Adult Population

Copayments Were Being Applied Incorrectly for the New ACA Adult Population 

 

HFS System Issue:

Copayments were being applied incorrectly for the new ACA adult population.

Problem:

The new ACA adult population is considered the same as the Medicaid Adult population and are subject to copayments outlined in Chapter 100, Appendix 12 (pdf). However, providers were having their payments reduced by $5.00 or $10.00 copayment amounts rather than the $3.90.

Providers Impacted:

Physicians, Chiropractors, Podiatrists, Optometrists, Advance Practice Nurses, Federally Qualified Health Center (FQHC), Encounter Rate Clinic (ERC), Rural Health Clinic (RHC) and Hospitals

Procedure Codes Impacted:

Any procedure code eligible for a copayment.

Problem Begin Date:

January 1, 2014

Problem Fix Date:

April 14, 2014

Resolution for Impacted Claims:

Providers may submit a void & rebill or a replacement claim. The department will accept electronic transactions submitted through MEDI or via 837P files to void or replace a payable or pending-payable claim if submitted within 12 months from the original paid voucher date.

Replacement claims – To replace a single service line or entire claim, enter Claim Frequency “7”. Detailed instructions on how to replace a claim electronically can be found in the Chapter 300, 837P Companion Guide. This method is preferred as it requires no manual override.

Void & Re-bill – This process involves two steps. The void portion may be completed electronically or on paper. Please refer only to step #1 for a void with no re-bill.

  1. To electronically void a single service line or an entire claim, enter Claim Frequency “8”. Detailed instructions on how to void a claim electronically can be found in the Chapter 300, 837P Companion Guide. A paper void may be completed by submitting a NIPS Adjustment Form HFS 2292, Instructions for which may be found in Chapter 100, Appendix 6 (pdf).
  2. Following completion of the void, a new original claim must be submitted within 90 days of the void DCN and may require manual override. If manual override is required, attach to a paper claim: a cover letter stating the reason for request for timely filing override.