The Pulse

Knowledge is power. "The Pulse" is our way of keeping you informed of industry news, market trends and what's happening at IPMS. Stay informed so you can stay ahead. Check back often for updates!

Medicare Coinsurance and/or Deductible Claims Submission!!:
Currently, when a coinsurance and/or deductible claim does not automatically crossover to EDS electronically, providers have the option of submitting a paper claim with a legible copy of the EOMB attached. The information on the paper claim must be the same information submitted to Medicare and must mirror the EOMB exactly.
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Health Net - Medicare Advantage:
Health Net Medicare Advantage members' benefit for Part B prescription medications will change from no coinsurance required in 2006 to the standard Medicare benefit of 20 percent coinsurance. The 20 percent coinsurance applies to all Part B injectables and biologicals, including chemotherapy medications.

National Provider Identifier (NPI):
As many of you are aware, the Centers for Medicare and Medicaid Services (CMS) have implemented a new identifier for use in electronic health care transactions.
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New Provider ID Number for Blue Care Family Plan Claims
On July 1, 2006, as a result of an Anthem Blue Cross/Blue Shield system conversion, the Blue Care Family Plan (BCFP) claims processing system has been converted to a regional claims processing system called Anthem Consolidated East System (ACES).
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Connecticut Department of Social Services - Medicare Crossover Claims
Recently, there was a change in how EDS will receive Medicare crossover claims. The Centers for Medicare and Medicaid Services (CMS) has partnered with a Coordination of Benefits Contractor (COBC), Group Health Incorporated (GHI) to consolidate all Medicare claims processing.
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NCCI Edit Reversal Good News for Spine Surgeons!
Spine surgeons had been disappointed to read the April 2006 NCCI edit - Version 12.1 --- which bundled 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace, single interspace; lumbar) into 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar).
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