Author: Provider Reimbursement
Effective Jan. 1, 2018, North Carolina Medicaid increased the rates for mammography procedure codes 77065, 77066, and 77067. Medicaid has identified the claims that have been affected by this change.
A systematic reprocessing for professional, Medicare Part B Crossover Professional, Rural Health Clinic (RHC), Local Health Department (LHD) and Federally Qualified Health Center (FQHC) claims with dates of service Jan. 1, 2018 through Feb. 23, 2018 – that were paid in NCTracks from Jan. 1, 2018 through March 6, 2018 – will be reprocessed in the June 12, 2018, checkwrite.
The reprocessed claims will appear in a separate section of the paper Remittance Advice (RA) with a unique Explanation of Benefits (EOB) code EOB 10245 - CLAIM REPROCESSED FOR 2018 RATE UPDATE FOR PROCEDURE CODES 77065, 77066 AND 77067.
The 835 electronic transactions will include the reprocessed claims along with other claims submitted for the checkwrite. (There is no separate 835.)
Reprocessing does not guarantee payment of the claims. While some edits may be bypassed as part of the claim reprocessing, changes made to the system since the claims were originally adjudicated may apply to the reprocessed claims. Therefore, the reprocessed claims could deny.
Provider Reimbursement
DMA, 919-814-0060