Update on Claims With New 2014 Codes to Pend - Revised Dates

New CPT and HCPCS codes go into effect on January 1, 2014. However, due to the federal shutdown, the states were delayed in receiving the new codes from the Centers for Medicare and Medicaid Services.

The State and CSC are actively engaged in the process of getting the policy and system aligned with the new codes, covered and non-covered, as well as the end-dated codes, to ensure that claims billed with the new codes will process and pay correctly.

Claims submitted from January 1 through January 8 with the new codes may deny for “procedure code not on file.� Providers can resubmit the claims once the codes have been loaded into the system and tested. To avoid this, providers may want to hold claims with the new codes until next week.

Beginning Thursday, January 9, providers will be able to bill Medicaid using the new codes. (This date is revised from the previous communication.) However, to avoid having the codes denied while the review and update is being completed; the rates will not be implemented for the new codes. This will cause the codes to pend for “rate not on file� instead of denying. The advantage to the provider is that once the update is complete, CSC will automatically recycle the pended claims and the provider will not need to resubmit them. This process will also be applicable to the Medicare crossover claims.

To maintain cash flow, providers may wish to split claims with the new codes from the other existing codes, where possible, so that the entire claim doesn’t pend.

The NC Department of Health and Human Services is currently reviewing the new procedure codes, rates, and the associated business policy and will be testing them in the next few weeks in NCTracks. We will provide weekly updates so that providers will know our progress.