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.
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.
Highmark Medicare Services is the Medicare Part B carrier for Pennsylvania and the Part B Medicare Administrator Contractor for Delaware, Maryland and the District of Columbia Metropolitan Area. Learn more about us in the about us section or browse our site below.
What's New in Part B
- August 28, 2008
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The Centers for Medicare & Medicaid Services (CMS) reported today that Medicare health care providers continue to be satisfied with services provided by Medicare fee-for-service contractors showing a relatively smooth transition to the new Medicare Administrative Contractors (MACs)
The summary report of the survey findings is available on the CMS Web site in the MCPSS section - click here.Â
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Transition Info
Watch this space for important information regarding upcoming transitions taking place in the Highmark Medicare Services organization. |
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Provider Information
A good resource of reference materials and information needed in your day-to-day interaction with the Medicare program. |
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Outreach & Education
Educational tools and materials to help you understand the ever changing Medicare program. Information you’ll need to help you submit claims correctly. |
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CERT
The CERT Program is a federally mandated, program integrity activity that was established by the Centers for Medicare and Medicaid Services (CMS) to monitor and improve the accuracy of Medicare payments to physicians and other non-physician practitioners. |
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