HFS System Issue:
DME claims with a maximum quantity allowed within a specific timeframe denied D17, Quantity Billed Requires Prior Approval.
On 9/11/2014, the system was changed to manage the quantities for a group of supplies. The change affected all DME codes with quantity limitations.
Durable Medical Equipment and Supplies Providers
Procedure Codes Impacted:
All DME HCPC codes that are coded PA Req: N and the Max Quan/ Days field is populated on the fee schedule which can be viewed at http://www.illinois.gov/hfs/MedicalProviders/MedicaidReimbursement/Pages/DME.aspx
Problem Begin Date:
Claims received on or after 9/11/14.
Problem Fix Date:
Resolution for Impacted Claims:
Providers must rebill.