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Highmark Medicare Services administers the Part B business for Pennsylvania (PA), and is the Part A Medicare Administrative Contractor (MAC) for Pennsylvania (PA), Maryland (MD) and the District of Columbia (DC) and the Part B MAC for Maryland (MD), Delaware (DE) and the District of Columbia Metropolitan Area (DCMA). Learn more about us.
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+(CREATED: 08/21/2008 at 3:25 PM) FISS and CWF Edits Deductibles (click for details)
Highmark Medicare Services is currently investigating a potential problem with claims that are inappropriately receiving FISS and CWF edits concerning deductibles. We are suspending those claims to status location SMDEDT while the problem is being researched. We appreciate your patience while we research this problem and will notify you when the problem has been resolved.
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+(CREATED: 08/18/2008 at 3:30 PM) Clinical Lab and Radiology Services Denied Incorrectly for MD/DCMA/DE Part B (click for details)
An issue has been identified concerning certain clinical laboratory and radiology services that are incorrectly denying with Ref Remark Code N347 indicating that the service was paid by another contractor. The denials are resulting from claims that were posted to the Common Working File (CWF) from the TrailBlazer's 7/10/08 batch cycle for MD/DCMA/DE Part B claims. The CWF reply file from the posting of those claims was not entered into the first batch cycle for Highmark Medicare Services by the Enterprise Data Center. When Highmark Medicare Services resent the same claims to CWF in an attempt to repost for payment, CWF rejected the claims as having already been approved for payment by TrailBlazer. These CWF rejections resulted in incorrect claim denials. Highmark Medicare Services will identify the claims impacted by the incorrect denial and will automatically adjust the claims for proper payment. Additional information concerning the recovery process will be posted to our website when available. We apologize for any inconvenience this has caused.
+(CREATED: 08/18/2008 at 8:26 AM) Limiting Charge Letters Distributed (click for details)
Early in August our claims processing system inadvertently allowed the distribution of limiting charge monitoring letters. Several years ago, the CMS discontinued the Limiting Charge Exception Report and the sending of compliance monitoring letters. Carriers are only required to assist beneficiaries in obtaining overcharge refunds from providers when brought to their attention. If you received a monitoring letter with instructions to refer to a limiting charge exception report, please disregard it as it was sent in error. You will not be receiving a report.
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