Key Message Image
Provider Alert Archive


Date: 9/2/2008
Description: Claims Denied Incorrectly Due to System Error on 8/29/08
Alert: Medica has identified a claims processing error for hospital and physician claims processed on August 29, 2008. A portion of Medica commercial and Minnesota Health Care Programs claims processed on this date were inappropriately denied with denial reason code 22 ("Not an eligible charge; do not bill patient"). Medica has taken steps to correct this and will reprocess all affected claims. Providers should notice adjustments to such claims within 90 days.
Action: No action is needed at this time as Medica will have all affected claims reprocessed. Providers do not need to submit adjustment requests.

Date: 8/25/2008
Description: Claims Denied Incorrectly for Hospital and Physician Services
Alert: Medica has identified a claims processing error for hospital and physician claims processed on August 13, 2008. All Medica Choice Product claims processed on this date were inappropriately denied with denial reason code 68 (“Your plan does not cover this expense”). Medica has taken steps to correct this and will reprocess all affected claims. Providers should notice adjustments to such claims within 90 days.
Action: No action is needed at this time as Medica will have all affected claims reprocessed. Providers do not need to submit adjustment requests.

Date: 8/25/2008
Description: 'Insights by Medica' Claims Paid Incorrectly for Hospital and Physician Services
Alert: Medica has identified a claims processing error for hospital and physician claims with dates of service from January 1, 2008, through July 29, 2008, for services provided to Patient Choice InsightsSM by Medica members. A portion of claims were not reimbursed correctly based on the appropriate fee schedule. The following places of service (POS) were affected by this issue: 21-24 (IP Hosp, Out-PT Hosp, ER and Ambulatory Surgery Ctr.), 26 (Military Treatment Facility), 31 (SNF), 34 (Hospice), 41-42 (Ambulance land & air), 51-53 (IP Psychiatric Facility, Psychiatric Facility – Partial Hospitalization and Community MH Care), 56 (Psychiatric Residential Treatment Center) and 61 (Comprehensive IP Rehabilitation Facility).

This issue did not apply to claims that were billed using the following modifiers: AA, AD, QK, QS, QX, QY and QZ. Medica has taken steps to correct this and will reprocess all affected claims. Providers should notice adjustments to such claims within 90 days.
Action: No action is needed at this time as Medica will have all affected claims reprocessed. Providers do not need to submit adjustment requests.
Product Impact: Only Patient Choice Insights by Medica claims are affected by this issue.
Date: 8/22/2008
Description: Medica to Update Policy on Avastin to Cover Treatment of Ovarian Cancer
Alert: Medica will update its coverage policy on bevacizumab (Avastin®) to also cover bevacizumab treatment when used for metastatic ovarian cancer, effective with September 1, 2008, dates of service. The change is due to this condition no longer being considered investigative. As of September 1, the updated coverage policy will be available online at www.medica.com in the "Providers" section, under "Clinical & Quality Resources," then "Medical Policies," under "Coverage Policies."
Action: No action is necessary. To bill Medica for this service on or after September 1, providers may use current applicable HCPCS code J9035 (Injection, bevacizumab, 10 mg).

Date: 8/21/2008
Description: Claims Denied Incorrectly for Pediatric Behavioral Health Screening
Alert: Medica has identified a claims processing error involving CPT code 96110 UC, used for pediatric behavioral health screening. The claims were denying for an inappropriate diagnosis, with denial reason code 478 or OM, when submitted with a preventive diagnosis. The error was identified and the system has been corrected as of August 18, 2008. Medica will be identifying all inappropriately denied claims for reprocessing. Providers should notice adjustments to such claims within 90 days.
Action: Providers do not need to submit adjustment requests. Medica will have all affected claims reprocessed.

Date: 8/21/2008
Description: Claims Denied Incorrectly for Initial Hospital Care of Neonate
Alert: Medica has identified a claims processing error involving CPT code 99477, used for initial hospital care of a neonate. The claims were denying for requiring a modifier, with denial reason code 093 or MQ. The error was identified and the system has been corrected as of July 30, 2008. Medica will be identifying all inappropriately denied claims for reprocessing. Providers should notice adjustments to such claims within 90 days.
Action: Providers do not need to submit adjustment requests. Medica will have all affected claims reprocessed.

Date: 8/15/2008
Description: Medica Covers 3 Newly FDA-Approved Vaccines
Alert: Medica covers the following vaccines, as specified. These immunization drugs were recently approved by the U.S. Food and Drug Administration (FDA).
  • Kinrix – On 6/24/08, the FDA approved Kinrix, a combination vaccine that offers protection against diphtheria, tetanus, pertussis, and polio in a single shot. As of the FDA approval date, related CPT code 90696 is eligible for reimbursement for all Medica members.
  • Pentacel – On 6/20/08, the FDA approved Pentacel, a combination vaccine that combines diphtheria, tetanus, pertussis, polio and Haemophilus influenza type b (Hib) vaccines into a single shot. As of the FDA approval date, related CPT code 90698 is eligible for reimbursement for all Medica members.
  • Rotarix – On 4/3/08, the FDA approved Rotarix, a live, oral, vaccine for use in preventing rotavirus gastroenteritis in infants. Rotarix is a liquid vaccine given by mouth in two doses. As of the FDA approval date, related CPT code 90681 is eligible for reimbursement for Medica members through 12 months of age. Claims received outside this age restriction will be denied as provider liability.
Action: Providers can bill for these 3 vaccines, as necessary. If you have questions, you can call the Medica Provider Service Center toll-free at 1-800-458-5512.

Date: 8/15/2008
Description: Medica's claim processing system is tentatively scheduled to be updated to include the 2009 MS-DRG changes on October 1, 2008
Alert: The Centers for Medicare and Medicaid Services (CMS) published the fiscal year (FY) 2009 Medicare Severity (MS) Diagnosis-Related Group (DRG) changes scheduled for publication in the August 19, 2008, Federal Register. The final rule to the FY 2009 inpatient prospective payment system can be accessed through the following link:

http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/CMS-1390-F.pdf

The IPPS inpatient rule includes 999 MS-DRGs for 2009. For 2009 the MS-DRG weights are based on 100 percent to the cost determined MS-DRG values.

Medica’s claim processing system is tentatively scheduled to be updated in mid-November. Although implementation of the 2009 MS-DRG update will occur in November, consistent with CMS, the effective date of implementation will be October 1, 2008. Additional detail regarding the timeline will be provided in the next thirty days.
    Action: Should this change require an alteration to your reimbursement, your Contract Manager will contact you.
    Date: 8/15/2008
    Description: Medica plans to implement ‘Present on Admission’ requirement for inpatient acute care PPS hospitals for Medicare product claims on October 1, 2008
    Alert: The Centers for Medicare and Medicaid Services (CMS) published the fiscal year (FY) 2009 Inpatient Prospective rule on July 31, 2008. For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission. That is, the case would be paid as though the secondary diagnosis were not present. Medicare has been requiring the POA indicator since October 1, 2007. The final rule to the FY 2009 inpatient prospective payment system can be accessed through the following link:

    http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/CMS-1390-F.pdf

    Medica is not requiring the Present on Admission indicator at this time for non Medicare claims.
    Action: Report the Present on Admission indicator on Medica’s Medicare product claims where Medica is primary starting on October 1, 2008.
    Date: 8/15/2008
    Description: PRA Balancing Issues
    Alert: Medica has identified a system error involving some types of claim adjustments causing balancing issues on provider remittance advices (PRAs) for claims processed on the Cosmos platform. Some fields, including the “Adjusted amount” and “Provider Totals,” may not balance; however, the check payment amounts are correct. A system fix is scheduled for August 24, 2008.
    Action: No action is needed at this time. Providers do not need to submit adjustment requests.

    Date: 8/8/2008
    Description: Medica to Implement EPRA Enhancements Related to New Administrative Platform
    Alert: Medica will soon implement several enhancements to its electronic provider remittance advice (EPRA) for claims processed on the new administrative platform only. These changes in the HIPAA 835 transaction should improve both convenience and security of EPRAs for providers. The date for these changes is tentatively August 19, 2008. The five scheduled updates are:
    • Group/policy numbers will be split into a separate field from the 9-digit member ID number as part of the HIPAA 835 transaction (numbers are currently all combined).

    • New remark codes will be used regarding individual claims:
      A1 = Claim/Service Denied
      16 = Claim/service lacks information which is needed for adjudication
      17 = Payment adjusted because requested information was no provided or was insufficient/incomplete
      96 = Non covered charge(s)
      125 = Payment adjusted due to a submission/billing error(s)

    • On the EPRA for institutional claims, the national provider identifier (NPI) for the billing provider will show up under "Servicing Provider NPI."

    • For adjusted claims, the HIPAA 835 transaction will reflect the NPI number submitted on the original claim.

    • Bulk recovery claims reported in HIPAA 835 transactions will contain the entire patient account number (not truncated) as submitted on the original claim.
    Action: Providers may need to update programming for acceptance of these EPRA format changes. You can get further details about these enhancements online in a related EPRA Enhancements reference document. If you have questions, you can call the Medica Provider Service Center toll-free at 1-800-458-5512.

    Date: 7/31/2008
    Description: E&M Add-On Codes for Prolonged Services and Critical Care Services Inappropriately Denying.
    Alert: Medica has identified a system error for claims processed since March 2008. Approximately 450 claims across all products have denied inappropriately to date as provider liability with denial reason code 277 ("Claim Has Already Been Processed and Paid"). Medica is investigating the system error and once resolved a report will be run to identify all affected claims for reprocessing.
    Action: No action is needed at this time. Medica will adjust claims as necessary. Providers do not need to submit adjustment requests.

    Date: 7/11/2008
    Description: System Error Causing Inappropriate Denials for Physician Claims Processed on 6/30/08.
    Alert: Medica has identified a system error for professional claims processed on 6/30/08. A portion of claims processed on 6/30/08 were inappropriately denied using reason denial code 478 ("Diagnosis inappropriate for procedure"). Medica has corrected the system error and will reprocess all affected claims.
    Action: No action is needed at this time. Providers do not need to submit adjustment requests.

    Date: 6/6/2008
    Description: Medica to Reprocess Imaging Claims That Were Incorrectly Denied
    Alert: Medica has identified a system error related to high-tech imaging claims that were inappropriately denied for lack of notification. This issue applies to Passport from Medica claims processed from February to May 2008 for employer groups excluded from the high-tech imaging requirement. Medica has corrected the system error, is identifying all affected claims, and will reprocess these claims. For providers who have already submitted an appeal related to this issue, note that claims will be identified and reprocessed. Providers should see claim adjustments within 60 days.
    Action: No action needed at this time. Providers do not need to submit adjustment requests.

    Date: 5/23/2008
    Description: Formulary Availability to Change on Epocrates Rx
    Alert: Beginning June 2, 2008, only Medica Part D formularies will be accessible through Epocrates Rx. Medica commercial and state-sponsored plan formulary remains available through Medica’s Web site and can be downloaded onto a PDA by accessing the Minnesota Council of Health Plans Web site. Clinicians can use these same resources to check drug coverage restrictions (e.g., utilization management) and placement of formulary alternatives, as applicable. These resources, like Epocrates Rx, are free of cost to the user.
    Action: For more information about this change, or to access the Medica formulary online, visit the Pharmacy Resources page.

    For PDA downloads of Medica’s commercial and state-sponsored plan formulary, visit http://www.mnhealthplans.org/healthplans/prescrip_drug.shtml

    For Medica Part D formularies that remain available on Epocrates Rx, visit http://www.epocrates.com/formulary/online.html.

    Date: 5/19/2008
    Description: Medica’s PRA has been updated to include additional information
    Alert: Medica's Provider Remittance Advice (PRA) has been updated to include additional information. Changes were implemented May 17, 2008.
    Action: The following reference tools explain formatting of the new PRA.

  • Medica’s New Provider Remittance Advice
  • Provider Remittance Advice Explanation of Fields

    • Date: 5/5/2008
    Description: Digitek heart drug recalled
    Alert: Digitek®, used in the management of heart failure and abnormal heart rhythm, was voluntarily recalled recently by its manufacturer. The decision to recall this medication was due to the potential for this drug’s tablets to contain as much as twice the approved level of active ingredient. Medica is notifying Medica members taking Digitek and asking them to contact their doctor or pharmacist as soon as possible before taking their next dose. Medica will no longer allow pharmacies to process Digitek claims.You can find additional information about this recall:
    Action: Providers are encouraged to discuss this with their patients.
    Date: 4/22/2008
    Description: System error caused inappropriate denials for claims processed on 4/21/08
    Alert: Medica has identified a system error for claims processed on 4/21/08. A portion of Medica commercial and Medicare claims processed on 4/21/08 were inappropriately denied with reason code 487 ("Service investigational/experimental"). Medica has corrected the system error and will run a report to identify all affected claims to be reprocessed.
    Action: No action needed at this time. Providers do not need to submit adjustment requests.
    Date: 4/9/2008
    Description: Correct Code Needed for Billing of Part D Vaccine Administration
    Alert: Providers should be billing with code G0377 (Administration of vaccine for Part D drug) instead of code 90471 after administering a Part D vaccine such as Zostavax, Gardisil, Varivax, Manictra, Vaqta/Havrx , Twinrx, measles/mumps/rubella MMR, tetanus/diphtheria (TD), etc. -- Code 90471 should only be billed when administering non-part D vaccines.
    Action: Using correct vaccine code when billing.
    Date: 4/4/2008
    Description: Description Corrected for 251 Disallow/Denial Code on Certain Medicare Claims
    Alert: This is a follow-up notice to a prior issue. Medica has corrected the description for disallow/denial code 251 applied to claims for the Medicare product Medica Prime Solution. As of 4/4/08, the description of the 251 code has been changed back to the correct code description: "Doesn't meet Medicare LDC/NCD criteria."
    Action: Again, related claims have been processed correctly, so no further action is required.
    Date: 3/31/2008
    Description: Description Incorrect for 251 Disallow/Denial Code on Certain Medicare Claims
    Alert: Medica has identified an error to the description for disallow/denial code 251 applied to claims for the Medicare product Medica Prime Solution. Despite this inaccurate description, however, the actual claim denials have been processed correctly. Until 3/14/08, the denial explanation correctly read "Doesn't meet Medicare NCD/LCD Criteria." On 3/15/08, the language changed to "Payment of Medicare Copay/Coinsurance," which is an incorrect description. Medica is working on a resolution to this issue and will send a follow-up notice once it is complete.
    Action: No action required.
    Date: 3/14/2008
    Description: Hyaluronan injection claims processed incorrectly
    Alert: Medica has identified a processing error for 2008 HCPCS codes J7321-J7324 & 2007 HCPCS codes Q4084-Q4086. Some claims were denied inappropriately when they should have been processed for payment, where other claims were paid inappropriately and should have been denied. This error started with dates of service from 11-1-07 to current. Medica is currently working to update systems to have these claims process correctly. Once the systems have been updated, all impacted claims will be identified and will be reprocessed accordingly. Providers should notice the adjustment within 90 days.
    Action: Providers do not need to submit adjustment requests. All affected claims will be reprocessed.
    Date: 2/29/2008
    Description: System error causing inappropriate 022 denials for claims processed on 2/27/08
    Alert: Medica has identified a system error for claims processed on 2/27/08. A portion of claims processed on 2/27/08 were inappropriately denied reason 022 (not an eligible charge, do not bill patient). Medica has corrected the system error and will run a report to identify all affected claims for reprocessing.
    Action: No action needed at this time. Providers do not need to submit adjustment requests.
    Date: 2/29/2008
    Description: Medical Dental Claims Processed Incorrectly
    Alert: Medica has identified a processing error for American Dental Association (ADA) codes D9220, D9610 and D9612. Claims with these codes were inappropriately denied when they should have been processed for payment under a member’s medical-based dental benefit. This error dates from 10-1-06 to current dates of service. Medica is working to update its claims systems to have these claims process correctly. Once the systems have been updated, all claims affected by this error will be identified and reprocessed accordingly. Providers should notice adjustments within 90 days.
    Action: Providers do not need to submit adjustment requests. All affected claims will be reprocessed.
    Date: 12/07/2007
    Description: Limited Availability of Medica Electronic Transactions This Weekend.
    Alert: From midnight Friday, December 7, to midnight Sunday, December 9, there will be limited availability of Electronic Transactions (e.g., copay info, eligibility) on www.medica.com. This is due to scheduled maintenance. We apologize for any inconvenience.
    Action: No action required.
    Date: 12/06/2007
    Description: Changes to the 835 transaction.
    Alert: On 11/17, Medica made changes to the 835 transaction (electronic provider remittance advice) produced from our Cosmos claim payment system. The changes include correcting the calculation of the Allowed Amount reported in the AMT segment using the B6 qualifier to reflect the true allowable amount (including the copayment and physician contingency reserve which may be returned to the provider at a later date), reporting NDC codes in the SVC segment using the N4 qualifier and reporting federal tax withholding in the PLB segment using the IR qualifier.
    Action: Providers should contact their system vendors to ensure these changes will be accurately reflected within their account posting system. Contact the Provider Service Center for additional assistance at 1-800-458-5512.
    Updated: 11/8/2007
    Date:     10/11/2007
    Description: Problems with HIPAA 270/271 online transactions have been resolved for most members.
    Alert: Medica has corrected certain issues with the HIPAA 270/271 online transactions. When checking eligibility on www.medica.com, providers will now be able to verify copay and coinsurance, out of pocket, and deductible for most Medica members. Product descriptions are also now available, as are primary care clinic (PCC) designations for care system products Elect, Essential, and Focus. However, note that for members whose claims are handled on the new claims administration system, the eligibility transaction will continue to display zeros for copay and coinsurance, out of pocket, and deductible information.
    Action: If you receive incomplete information, as indicated above, when checking eligibility online, please contact the Medica Provider Service Center at 1-800-458-5512.

    Update (11/8/2007): The issues with the HIPPA 270/271 online transaction have been corrected. Providers will now be able to use the transactions to check nformation on Primary Care Clinic, address, copay, deductible and out of pocket information.
    Update (10/25/2007): The HIPAA 270/271 online transactions will be providing a limited data until further notice. Please note the transaction will display name, date of birth, group number, alt id, coverage start and end dates. Information on Primary Care Clinic, address, copay, deductible and out of pocket information will not be provided.

    Date: 10/11/2007
    Description: Certain CPT codes incorrectly denying with reason code 223.
    Alert: Medica has identified a system error when CPT codes 94750, 94760, 94761, 94762, 94770 and 94772 were submitted and denied with reason code 223 (“Place of service inappropriate for procedure”). This applies to dates of processing of 09/05/2007 through 10/05/2007. Medica is working to identify all impacted claims and will reprocess accordingly. Providers should notice the adjustment within 90 days.
    Action: Providers do not need to submit adjustment requests. All affected claims will be reprocessed.
    Date: 9/19/2007
    Description: Medica IT continues to work on resolving the problem with the HIPAA 270/271 online transactions.
    Alert: Medica IT continues to work on resolving the problem with the HIPAA 270/271 transactions (eligibility inquiry and response) on www.medica.com. In the meantime, Medica will continue to support the "fall back" mode for HIPAA 270/271 transactions. This option allows for all eligibility transactions to be processed; however, the response will only include effective and expiration dates and not copayment, co-insurance, amount of deductible satisfied, etc. Medica is continuing work to correct this issue, but at this time, there is not an anticipated fix date for the problem to be resolved. Medica will post information on the status of this resolution as it becomes available.
    Action: If you should need to verify member copay, coinsurance or deductible information, please contact the Provider Service Center at 1-800-458-5512 (this information is available in automated self-service format through this phone line as well).
    Date: 8/17/2007
    Description: Medica's claim processing system is tentatively scheduled to be updated to include the 2008 MS-DRG changes on October 1, 2007
    Alert: The Centers for Medicare and Medicaid Services (CMS) published the fiscal year (FY) 2008 Medicare Severity (MS) Diagnosis-Related Group (DRG) changes in the August 1, 2007, Federal Register. The final rule to the FY 2008 inpatient prospective payment system can be accessed through the following link:

    http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/CMS-1533-FC.pdf

    The IPPS payment reforms would restructure the inpatient diagnosis-related groups (DRGs) to account more fully for the severity of each patient’s condition. The rule continues to phase in a change introduced in FY 2007 which would better align payment with the costs of care by using estimated hospital costs, rather than list charges, to establish relative weights for the DRGs.

    This year, the rule creates 745 new severity-adjusted diagnosis-related groups (Medicare Severity DRGs or MS-DRGs) to replace the current 538 DRGs.

    Medica’s claim processing system is tentatively scheduled to be updated to include the 2008 MS-DRG changes on October 1, 2007. Medica’s system is typically not updated until December due to the need for system programming and testing. However, due to the significant impact of the new rule, Medica plans to implement this update to be aligned with CMS.

    Action: Should this change require an alteration to your reimbursement, your Contract Manager will contact you.
    Date: 8/01/2007
    Description: Medica Web Site Navigation Streamlined.
    Alert: Medica’s Web site has a new streamlined look. The content is simply reorganized for providers to find and access it more easily. The main drop-down links are now embedded in the “Providers” home page (http://provider.medica.com/default.aspx), which is now a hub through which all provider-focused content is available. The main change is to the top “navigation” bar for provider information, with a modified menu of seven items. These top-level topics include:

    * “Electronic Transactions” — currently the most-used function within Medica’s provider Web pages;
    * "Reference Tools and Forms" — A new operations-focused area with resources such as administrative manuals, policies, reference documents, claim-related forms, and tools for credentialing and demographic updates;
    * "News You Can Use" — A news-focused category containing past editions of Medica Connections® newsletters as well as Provider Alerts;
    * "Clinical & Quality Resources" — A new section that will be home to medical policies, clinical guidelines, prior authorization requirements, the Centers of Excellence program list of approved bariatric facilities, and information about Medica’s clinical and quality-improvement programs.
    Action: Bookmarks to existing Web pages should continue to work. No action is required.
    Date: 7/27/2007
    Description: Coding Questions e-mailbox to no longer be available.
    Alert: After September 4, 2007, the Medica Coding Questions e-mailbox (coding.questions@medica.com) will no longer be available, and the fax line for this resource will also no longer be availabe. Coding questions will need to be reviewed within the individual organization. Medica offers online coding tools, including a table of frequently asked questions for provider use. Inquiries beyond provider staff capabilities may be directed to Medica's Provider Service Center.
    Action: As an alternative to the Medica Coding Questions e-mailbox, providers are encouraged to use resources within their individual organizations as well as resources available on online. Visit www.medica.com to refer to Coding Tools and Forms (http://provider.medica.com/C12/CodingToolsForms/default.aspx). After exhausting these resources, providers may contact the Provider Service Center regarding a coding inquiry, and when doing so should be prepared to provide specific claim details including audit number, date(s) of service, and procedure code.
    Date: 7/17/2007
    Description: CPT codes 92340-92342 and 92370-92371 incorrectly denying with reason code 664
    Alert: Medica has identified a system error for CMS-1500 claims when CPT codes 92340-92342 and 92370-92371 were submitted and denied with reason code 664 ("Eyeglasses/ contacts are not covered"). This applies to dates of processing of 4/18/07 to 7/2/07. This error only impacted claims submitted on behalf of Medica’s Minnesota Health Care Programs members. Medica has corrected the system and has identified all impacted claims. Providers should notice the adjustment within 60 days.
    Action: Providers do not need to submit adjustment requests. All affected claims will be reprocessed.
    Products Impacted: Medica Choice CareSM and Medica MinnesotaCare (not including MinnesotaCare Limited) -- group numbers 59119, 59619, 59117, 59617, 59118, 59618, 59517, 59717, 59518, 59718, 59523, 59723, 59522, 59722, 59524, 59724.
    Date: 6/28/2007
    Description: Medica COB Policy to be Consistent for All Claims
    Alert: Medica has implemented a systems change to be consistent in investigating coordination of benefits (COB) on an initial claim for each new member, regardless of the claims administration system used. As a result, COB information will be pursued with the first claim per member for all Medica claims; there will be no threshold with a $400 claim level required prior to pursuing COB for any claims processed on Medica's new claims administration system.
    Action: No action required.
    Date: 6/13/2007
    Description: Medica.com Eligibility Transaction Has Errors When the Primary Care Clinic is Loaded with an NPI number
    Alert: Medica.com eligibility transactions can not be executed when an NPI number is used for the primary care clinic. Medica is working to correct this issue and plans to have this error corrected mid-August. This error only affects transactions on www.medica.com. This does not affect other electronic vendors such as Emdeon or ClaimLynx.

    Update: Medica regrets that the above error has not yet been resolved.  Medica remains committed to fixing the error and hopes that the error will be fixed soon.  Until the fix is implemented, the transaction will display limited data, only verifying if a member is eligible or not (no PCC or copays will display).
    Action: If you receive an error when checking eligibility on www.medica.com, please contact the Provider Service Center at: 1-800-458-5512.
    Date: 6/12/2007
    Description: Medica's new process for set-up of NPI numbers
    Alert: Medica is transitioning its ongoing maintenance of systems set-up for all national provider identifier (NPI) numbers -- both facility and individual practitioner NPIs. This change is effective immediately. To submit NPIs to Medica, please use the standard process followed for all demographic change requests. Click on the following link to see how to notify Medica of such changes: http://provider.medica.com/C18/ProviderDemo/default.aspx. Providers may use either the Minnesota HIPAA Collaborative NPI submission form or the Minnesota Uniform Practitioner Change Form to send Medica NPIs. These forms may be returned to Medica by e-mail at demographicchangerequests@medica.com, by fax to 952-992-2249, or by U.S. mail to this postal address:
    Medica Provider Demographics
    Route CP412
    PO Box 9310
    Minneapolis, MN 55440-9310
    If you haven't already submitted your NPI to Medica, it may take 2-3 weeks to set up the NPI numbers in the Medica system before you can begin using the NPI on claims. Medica confirms receipt of NPI submissions. Then, prior to submission of an NPI on claims, providers can verify the existence of an NPI in Medica's system. To do this, use the Provider Search function (under Electronic Transactions, at http://provider.medica.com/C6/ElectronicTransactions/default.aspx) -- which indicates NPIs associated with each provider. Otherwise, providers may call the Provider Service Center at 1-800-458-5512. Referring providers can also use the search function to find NPIs for other providers (specialists, hospitals, etc.).

    As a reminder, until further notice, you may use your NPI number and/or your Medica ID number to submit claims to Medica.
    Action: If you have not already done so, please submit your NPI numbers using the above e-mail, fax or mailing address. If you have questions, an NPI Q&A is available at http://provider.medica.com/C13/ClaimsToolsForms/default.aspx, or you may call the Provider Service Center.
    Date: 5/25/2007
    Description: Medica's turnaround time for set-up of NPI numbers
    Alert: Due to a last-minute rush of national provider identifier (NPI) numbers submitted to Medica, Medica may require 2-3 weeks to set up the NPI numbers in its system before providers can begin using the NPI on claims. If you submitted your NPI in an ENUF file, the turnaround time is the quickest, at one week, after which you should be able to submit claims using your NPI. As a reminder, until further notice, you may continue to use either your NPI number or your Medica ID number to submit claims to Medica.
    Action: If you have not already done so, please submit your NPI numbers, including a unique identifier for each practitioner (SSN, UPIN, Medica billing number), using an ENUF file to David Andersen at david.andersen@medica.com. If unable to submit using an ENUF file or an electronic Excel list, fax NPIs to Medica at 952-992-3270 (note that this is a corrected fax number). The fax machine has been in constant use, so if you fax and receive a busy signal, you may need to try submitting your information more than once.
    Date: 5/24/2007
    Description: UHC contract changes may affect EDI vendors
    Alert: With its recent acquisition of Electronic Network Systems, Inc. (ENS) and Claredi, UnitedHealthcare aims to streamline EDI processes. As a result, UHC is renegotiating its contracts with fee-based vendors/clearinghouses that providers may be relying on to submit claims. These contract changes should not affect how providers submit claims. However, the submission of EDI claims is outside Medica's control since that is a function of these vendors. Clearinghouses should be able to continue sending and receiving all of the transactions that they do now, with no impacts to providers.
    Action: If you have questions or concerns regarding the service provided by your clearinghouse, you should contact your vendor directly. Medica offers a guide outlining the services provided by some of the most prominent vendors/clearinghouses. To view this guide, click here. Or on www.medica.com, visit Provider Resources, then General Tools and Forms, under Electronic Commerce.
    Date: 5/18/2007
    Description: Effective immediately, providers may begin submitting claims using NPI only.
    Alert: Medica is ready to accept claims submitted with a national provider identifier (NPI) number only, as the Medica provider ID is no longer required. This applies for all paper and electronic claim formats (CMS-1500, UB-04, and 837). Please note that, until further notice, you may continue to use either your NPI number or your Medica ID number to submit claims to Medica.
    Action: If you have not already done so, please send a list of your NPI numbers to David Andersen at david.andersen@medica.com or by fax to (952) 992-2764. For additional information on how to complete the UB-04 or the new CMS-1500 claim forms, please click on http://provider.medica.com/C13/ClaimsToolsForms/default.aspx or visit www.medica.com, in the Provider Resources section under Tools and Forms, then Claims Tools and Forms. Finally, more NPI-related details were included in the June 2007 Medica Connections, available at this Web page: http://provider.medica.com/Connections/default.aspx.
    Date: 5/14/2007
    Description: Online Co-pay and Co-Insurance Verification for Groups on New Business Platform Inaccurately Showing $0.00
    Alert: Medica has identified an issue with co-pay and co-insurance inaccurately showing $0.00 for groups on new business platform. When checking online eligibility for these groups, the co-pay line will read $0.00 and the co-insurance line will appear blank. This issue affects medica.com transactions as well as transactions for all other claims vendors.
    Action: Medica is working to resolve this issue and will provide notification when this issue has been corrected. Please continue to check member ID cards and use the Provider Service Center to verify co-pay and co-insurance amounts for these members. Providers can contact the Provider Service Center at: 1-800-458-5512.
    Products Impacted: All groups on new business platform: Allianz (group # 710287), Ameriprise (group # 708550), General Dynamics (group # 217725), Nestle (group # 333000), Pepsi Co. (group # 191690), Pinnacle Airline (group # 710705), Unisys (group # 701182), Best Buy (group # 703352), Medica (group # 710668), Frandsen (group # 710724), Target (group # 185002), UHC (group # 168504), and Individual Business.
    Date: 3/30/2007
    Description: Medica's High-Tech Imaging Program - correction on fax number for appeals
    Alert: In previous communications, the fax number to use for submitting High-Tech Imaging Program administrative appeals was incorrectly published. The correct fax number to use is 952-992-3270. There is also a process in place at Medica to forward appeals that are submitted to the incorrect fax number.
    Action: As a reminder, performing providers can submit administrative appeal requests to Medica via mail, fax or e-mail:
    Medica
    Attn: CP345 Radiology Appeals
    PO Box 9310
    Minneapolis, MN 55440-9310

    Fax: 952-992-3270

    provider.analysts@medica.com
    Both the High-Tech Imaging Program Administrative Appeal Form and Appeal Policy have been updated and re-posted online under High-Tech Imaging on the Claims Tools and Forms web page at http://provider.medica.com/C13/ClaimsToolsForms/default.aspx.

    If you have questions or need further information about Medica's High-Tech Imaging Program:
    • See more details about the program at http://provider.medica.com/C13/ClaimsToolsForms/default.aspx
    • Call Medica's Provider Service Center at 1-800-458-5512
    Date: 3/09/2007
    Description: Medica's High-Tech Imaging Program - clarification that consultation requirement is not for performing providers
    Alert: Just as a reminder, Medica’s High-Tech Imaging Program requirement for making consultation requests applies to ordering providers only. The consultation process is intended to provide real-time decision support for physicians considering ordering high-tech imaging studies. This process does not apply for performing provider sites, so the only reason performing providers may need to contact HealthHelp is to verify that an ordering provider completed a consultation and a reference number was issued prior to performing the service.
    Action: As of March 1, ordering providers can use Medica's secure web page for online consultation requests. This is available on "Provider Resources" under Electronic Transactions. After logging in and selecting “Prior Authorization, Notification, and High-Tech Imaging Request,” click on the button for “High-Tech Imaging” on the next screen.

    If you have questions or need further information about Medica's High-Tech Imaging Program:
    • See more details about the program at Claims Tools and Forms
    • Call Medica's Provider Service Center at 1-800-458-5512.
    Date: 3/09/2007
    Description: Medica accepts UB-04 as of March 1, 2007
    Alert: Medica is ready to receive the new UB-04 as of March 1, 2007. For additional information on the UB-04 history and requirements, providers should review the Medica-specific guide to completing the UB-04 and well as the UB-04 FAQ posted on www.medica.com under the “Provider Resources” section, then “Tools and Forms”, then “Claims Tools and Forms” in the “Claim Forms” subsection (or at http://provider.medica.com/C13/ClaimsToolsForms/default.aspx). Medica will also be addressing the UB-04 changes in the upcoming Life of a Claim training sessions.
    Action: Please check www.medica.com and future editions of Connections for updates.
    Date: 3/08/2007
    Description: A portion of the new 2007 CPT codes were not added to Medica’s service code list until 2/12/2007.
    Alert: A portion of the new 2007 CPT codes were not added to Medica’s service code list until 2/12/2007. As a result, claims edited to the incorrect service code causing incorrect co-pays to be taken and limited services not being posted. The system was updated on 2/12/2007. This impacts all claims processed between 1/1/2007 and 2/12/2007.
    Action: No provider action required. Medica has identified all impacted claims and adjustments will be done accordingly.
    Date: 2/23/2007
    Description: Medica's High-Tech Imaging Program - program developments and additional tools
    Alert/Action: Here are several clarifications and program developments as part of Medica's consultation process for outpatient high-tech diagnostic imaging studies:
    1. As of March 1, providers will be able to use Medica's secure web page for online consultation requests. This is available on "Provider Resources" under "Electronic Transactions" (at https://provider.medica.com/C6/ElectronicTransactions/default.aspx)
      • A step-by-step guide will be available here to assist ordering providers with completing online consultation requests as of March 1.
      • Note: Ordering providers will need to include the performing provider Medica ID number with each online consultation request. A list of performing provider ID numbers is available on the secure web page as well as under "Tools and Forms," then "Claims Tools and Forms" in the "High-Tech Imaging" subsection (http://provider.medica.com/C13/ClaimsToolsForms/default.aspx)
      • Providers will need to have pre-registered for Medica's electronic transactions to be able to log in and use the secure web page. If you have not previously registered, please visit the secure web page indicated above or contact the Provider Service Center at the phone number below.
    2. With each consultation request, ordering providers can choose to include the fax number for the performing provider location. This will ensure that the reference number associated with a particular case is received by the performing provider. If the fax number for the performing facility is not included, the performing facility will not receive a fax. Best practice shows it is helpful for the ordering provider to also include the refererence number on the order to the performing facility. This confirms that a consultation was completed and enables appropriate payment for scans.
    3. If a scan needs to be scheduled the day of the consultation request, providers should call HealthHelp toll-free at 1-800-954-3040. Providers will also be able to make such expedited requests online as of March 1.
    4. Performing providers can verify the existence of a reference number for a requested scan by calling HealthHelp. Providers may also call the ordering provider's office to verify if a reference number has been issued.
    5. By March 1, a new list of product and provider exceptions to the High-Tech Imaging Program consultation requirement will be available under "Tools and Forms," then "Claims Tools and Forms" in the "High-Tech Imaging" subsection (http://provider.medica.com/C13/ClaimsToolsForms/default.aspx). This exception list will include two components:
      • This reference tool will list Medica's products with employer group numbers to assist both ordering and performing providers with understanding which patients are not included with this phase of the High-Tech Imaging Program -- These are members for whom the consultation process is not currently required.
      • Also listed on this reference tool are alternative provider programs -- Medica has approved certain provider entities that are using evidence-based criteria to have an alternative method to point-of service consultation. Ordering providers using these alternative programs, rather than Medica's consultation program, will not be required toobtain a reference number from HealthHelp. As a result, performing providers can perform scans ordered by providers of these organizations without a reference number and corresponding claims will not be denied.
    6. Starting next month, Medica's Provider College will be hosting weekly open forums by webinar to answer questions and address issues related to the High-Tech Imaging Program. You should soon see an invite to attend, which will include information on registering. If you have questions about these forums, send an e-mail to: providercollege@medica.com
    If you have questions or need further information about Medica's High-Tech Imaging Program:
    Action: [enter Action Text here]
    Date: 2/22/2007
    Description: High-Tech Imaging Open Forums are being offered every Friday through the month of March to address provider questions or concerns around the new high-tech imaging program
    Alert: Medica’s Provider College has invited you to join a meeting on the Web, using WebEx. These sessions will be held every Friday in March from 9-10 am. Each session will include helpful process tips and discuss any program developments, but the majority of the hour will be spent answering any questions you have about this program. Dedicated high-tech imaging program experts will be available to take your feedback and address any questions you may have.
    Action:
    • You can participate in the session by calling: 866-469-3239.
    • Web viewing not required to actively participate in the session.
    • Please click the following link to see more information, or to join the meeting: https://medica.webex.com/medica/j.php?ED=92563437&UID=54591342. NEW USER? Prepare your computer in advance of the meeting by clicking New User on the navigation bar.
    • For questions regarding a particular member, please continue to contact the Provider Service Center at: 1-800-458-5512.
    • Meeting number: 801 068 637
    • Meeting password: HealthHelp
    • Meetings being held every Friday in March starting March 2, 2007 through March 30, 2007
    • Time: 9:00 am – 10:00 am
    To add this meeting to your calendar program (for example, Microsoft Outlook or Lotus Notes), do the following:
    • For all calendar programs (except Lotus Notes), click the following link, or copy the link and paste it into your Web browser:
      https://medica.webex.com/medica/j.php?ED=92563437&UID=54591342&ICS=MI
    • For Lotus Notes, follow these steps:
      1. Right-click the attached iCalendar format (*.ics) file, and then choose View.
      2. Click Import All. A new broadcast email message is added to your Inbox.
      3. Open the new message.
      4. Click Respond button. A menu appears.
      5. Click Accept.
    The host requests that you check for compatibility of rich media players for Universal Communications Format (UCF) before you join the session. UCF allows you to view multimedia during the session. To check now, click the following link: https://medica.webex.com/medica/systemdiagnosis.php
    Date: 1/16/2007
    Description: Follow-up on notification with consultation requirement for ordering providers as part of Medica's new High-Tech Imaging Program
    Alert: As of January 1, Medica began rolling out a notification with consultation process for outpatient high-tech diagnostic imaging studies. Physician offices may participate in up to 3 levels of review to complete this process:
    1. For Level 1, the notification with consultation is with a client services representative, and the provider office should have a staff member with a clinical background consult with HealthHelp. 80% of the time, the process can be completed at Level 1, but the person making the call needs to be able to answer clinically scripted questions and have access to the patient's chart.
    2. If rules can't be met at Level 1 based on the information received, the call is sent on for a nurse-to-nurse review at Level 2. The additional review is only to answer additional questions and does not mean that your case does not meet rules. The Level 2 review may necessitate a callback from HealthHelp to your office for the additional information, which should take place within 4 hours of your call.
    3. If necessary after a nurse review at Level 2, the case may be referred to Level 3 for a physician-to-radiologist review.
    Reminder: Escalated reviews will never mean they are "denied." The process is consultative only, and a final decision on patient care continues to rest with the ordering physician.
    Action: To help cases meet rules at Level 1 so they don't need to move to Level 2, it would be helpful for ordering provider offices to have patient chart, notes or history available for initial consultations with HealthHelp. If submitting a fax form for a consultation request, complete the form as fully as possible. The form should contain as much information as necessary to describe why the requested procedure is being ordered. The required information only needs to be pertinent to the test being ordered. Doing this will help to facilitate quicker turnaround times for providers. Best practices for making requests have included:
    1. Having a clinical staff member make calls.
    2. Photocopying the fax form with unchanging provider information on it, so you don't have to repeatedly fill out the same information.
    3. Customizing the fax form to include clinical information that your office typically needs when ordering high-tech services.
    4. Highlighting Medica members on charge tickets so they're flagged as needing the outside notification (and reference number after completing the consultation).
    If you have questions or need further information:
    Date: 12/19/2006
    Description: Provider Service Center to phase out local number on Friday, December 29th
    Alert: Medica’s Provider Service Center currently offers the provider network two incoming phone options: local number 952-992-2232 and toll-free number 800-458-5512. To allow for heightened flexibility and capacity, the Provider Service Center will begin to phase out the local number on Friday, December 29th and will only use the toll-free number. Medica encourages providers to begin using the Provider Service Center’s toll-free number immediately. Medica is in the process of updating all provider materials to reflect only the toll-free number.
    Date: 11/22/2006
    Description: Access to existing provider portal transactions changing November 29, 2006
    Alert: Medica's new, more secure portal for online transactions, will be available on November 29, 2006, at which point providers will no longer have access to existing online transactions using their current username and password. As of next Wednesday, November 29th, all users will need to be registered in the new system and use their new username and password to have access to electronic transactions. Please register in advance of that deadline if you have not done so.
    Action: Each Organization’s Primary Administrator should register using the following steps:
    1. If possible, temporarily disable any pop-up blocker you may have running on your system
    2. Go to www.medica.com, hover your mouse over the Provider Resources tab and select Electronic Transactions
    3. Select the blue “Registration Account Management” link at the top of the page
    4. Scroll to the bottom of the page and select the “Register Provider Organization and Primary Admin” link
    5. When you click on "Submit," a window will pop up with a form that displays your information
    6. Print this form, review and sign it, and mail or fax it to Medica
    7. Once Medica receives your form, you will receive two e-mails: the first is acknowledgment of receiving the form, and the second will be a secure e-mail containing the link to complete the registration by setting up your username and password
    To assist you, a Registration User Guide has been posted in the Provider Resources section on www.medica.com under Administrative Manuals.

    If you have a question concerning registration, please contact us at portalregistration@medica.com or Contact Medica’s Provider Service Center at: 1-800-458-5512.
    Date: 11/09/2006
    Description: New mailing address for Medica claims
    Alert: Effective 11/1/2006 Medica changed the mailing address for paper claims from San Antonio, Texas, to the following:
    Medica
    PO Box 30990
    Salt Lake City, UT 84130
    Action: Medica encourages all providers to promptly update their systems to help ensure timely claims payment. The percentage of claims still submitted to the old address is very high.
    Date: 10/31/2006
    Description: Claims Address Changed
    Alert: Medica has changed the mailing address for paper claims from San Antonio, Texas, to Salt Lake City, Utah. Providers should be submitting claims to the following address:
    Medica
    PO Box 30990
    Salt Lake City, UT 84130
    Action: Providers should be sending paper claims and certified mail to the Salt Lake City, Utah address.
    Products Impacted: The new single address applies to all Medica lines of business (including Medica DUAL Solution® and Medica Advantage SolutionSM) except SelectCareSM, LaborCare® and United Behavioral Health (UBH).
    Date: 9/27/2006
    Description: Modifier QW Denials for Laboratory Codes – Only Affects Groups #168504 and #185002.
    Alert: Medica has identified a claims system error that is causing an incorrect denial on laboratory codes submitted with modifier QW (CLIA waived test). The denial reason is FE ("Incorrect Modifier"). Medica has requested a correction to the system with anticipated completion in October 2006. Following the correction to the system, Medica will run a report to identify all affected claims for reprocessing. Codes for laboratory services submitted without the QW modifier will process according to the provider contract.
    Action: No action is required from providers at this time.
    Date: 9/20/2006
    Description: Incorrect maternity benefit assignment to claims for Group #185002.
    Alert: Medica has identified a claims system error, which assigned an incorrect benefit to claims submitted for maternity services beginning with April 1, 2006, dates of service. A correction to the system was completed on August 22, 2006. Medica has identified all claims impacted by this error and is in the process of adjusting claims. The target completion date for adjustments is September 30, 2006.
    Action: No action is required from providers at this time.
    Date: 9/12/2006
    Description: Physician and Facility Claims Incorrectly Denied Reason Code 068 (Not a covered service).
    Alert: Medica has identified a claims system set-up error which caused both physician and facility claims to be denied with reason code 068 (Not a covered service). This only has an impact on claims with checkwrite dates of 9/6/2006-9/8/2006. Medica is in the process of identifying all claims that were inappropriately denied and adjustments will be done accordingly. Medica will continue to update providers as more information becomes available.
    Action: No action is required from providers at this time.
    Updated: 10/26/2006
    Date:     9/08/2006
    Description: System error causing inappropriate 251 denials for 3 vision codes submitted on CMS-1500.
    Alert: Medica has identified a system error for CMS-1500 claims when CPT codes 92081, 92083 and 92083 (visual fields) were submitted and denied with reason code 251 (Doesn’t meet NCD/LCD policy criteria). This applies to dates of processing of 6/19/06-9/07/06. This error should only have affected claims for services performed by MN and WI optometric and ophthalmological providers. Medica has corrected the system error and will run a report to identify all affected claims for reprocessing.
    Action: No action needed at this time. Providers do not need to submit adjustment requests.
    Update: All affected claims have been identified and reprocessed.
    Updated: 10/26/2006
    Date:     9/08/2006
    Description: System error causing inappropriate 251 denials for 2 diabetes-related HCPCS codes submitted on CMS-1500.
    Alert: Medica has identified a system error for CMS-1500 claims when HCPCS codes A5512 and A5513 (for diabetics only, multiple density inserts) were submitted and denied with reason code 251 (Doesn’t meet NCD/LCD policy criteria). This applies to dates of processing of 6/14/06-9/07/06. Criteria from two different DME policies was mistakenly combined, resulting in the incorrect denials. This error should only have affected claims for services performed by MN and WI suppliers of diabetic shoe accessories. Medica has corrected the system error and will run a report to identify all affected claims for reprocessing.
    Action: No action needed at this time. Providers do not need to submit adjustment requests.
    Update: All affected claims have been identified and reprocessed.
    Date: 8/18/2006
    Description: System error causing inappropriate 251 denials for CPT codes 97110, 97112, 97116, 97530, 97532, 97533, 97535 and 97537 submitted on a CMS-1500 or UB-92.
    Alert: Medica has identified a system error for CMS-1500 and UB-92 claims when CPT codes 97110, 97112, 97116, 97530, 97532, 97533, 97535 and 97537 were submitted and denied reason 251 (doesn’t meet NCD/LCD policy criteria) for dates of processing 6/5/06 – 8/19/06. Medica has corrected the system error and will run a report to identify all affected claims for reprocessing. Not all denials were inappropriate. Providers can access the Wisconsin Physicians Service (WPS) website for the most current policy criteria for Physical Medicine and Rehabilitation Procedures and Modalities.
    Action: No action needed at this time. Providers do not need to submit adjustment requests.
    Date: 8/11/2006
    Description: Coding Questions mailbox, expected turnaround time
    Alert: Due to staffing changes to support other Medica initiatives, Medica will temporarily have fewer resources dedicated to the "Coding Questions" email box and faxes which may result in a delayed response.  At this time we request providers not submit duplicate questions to the “Coding Questions” email box. However, providers who require immediate assistance may flag their question as such.

    NOTE: You may find additional resources available by utilizing the search functionality on medica.com in either “Connections” or the Reimbursement/Claims Policies.
    Date: 8/11/2006
    Description: Delay in loading electronic claims
    Alert: Medica is currently experiencing a 5-day turnaround time in the loading of electronic claims into its claims processing system. This is only affecting commercial claims. The claims are being loaded and processed in the order they are received. An update will be available as soon as the issue is resolved.
    Action: When checking claim status for electronic claims, please keep in mind there is a delay in load time.
    Date: 8/08/2006
    Description: Provider Service Center to Temporarily Change Service Hours
    Alert: Medica Provider Service Center will temporarily be changing its hours, closing from noon-1 PM Monday through Friday. This will be effective beginning Wednesday, August 9. The new hours will be:
    • Monday-Thursday: 8:30 AM to noon and 1-5 PM
    • Friday: 9 AM to noon and 1-5 PM
    This change is intended to reduce wait times by providing a full staff during all hours of operation. These temporary hours will be in place until further notice. We apologize for the inconvenience this may cause you or your office. Self-service options will continue to be available during this time via the automated phone system or www.medica.com. We will communicate future updates or changes to hours as necessary. We appreciate your patience.
    Date: 8/01/2006
    Description: Medica Claim/Reimbursement Policies now Available on medica.com
    Alert: Medica’s Claim/Reimbursement Policies have been posted online to assist providers with coding and submitting claims to Medica for covered health services.
    Action: Visit www.medica.com, under “Provider Resources,” “Tools and Forms,” then “Reimbursement/Claim Policies” (available directly at http://provider.medica.com/C14/ClaimPolicies/default.aspx). If you have questions on any of the listed policies, please send an e-mail to coding.questions@medica.com.
    Date: 7/28/2006
    Description: FDA Approves New Vaccine for Prevention of Cervical Cancer
    Alert: The Food and Drug Administration approved Gardasil, on June 8, 2006, the first vaccine developed to prevent cervical cancer, precancerous genital lesions and genital warts due to human papillomavirus (HPV) types 6, 11, 16 and 18. The vaccine is approved for use in females 9-26 years of age.
    Effective June 8, 2006, CPT code 90649 Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use will be eligible for reimbursement for females ages 9-26.
    Action: No action is required from providers.
    Date: 7/28/2006
    Description: System error causing inappropriate 251 denials for CPT lab code 80061 submitted on a CMS-1500 or UB-92.
    Alert: Medica has identified a system error for CMS-1500 and UB-92 claims where CPT lab code 80061 (Lipids panel) was submitted and denied reason 251 (doesn’t meet NCD/LCD policy criteria) for dates of processing 6/27/06 and forward. Medica has corrected the system error and will run a report to identify all affected claims for reprocessing.
    Action: No action needed at this time. Providers do not need to submit adjustment requests.
    Date: 7/28/2006
    Description: National Coverage Decisions (NCD) and Local Coverage Decisions (LCD)
    Alert: Medica is currently up to date with the National Coverage Decisions (NCD) and Local Coverage Decisions (LCD) for Medica Prime Solution, group numbers 70200-70299 and 70500-70599. Medica will have the newly created or revised NCDs and LCDs reviewed and implemented in our claims system within 30 days of receipt of notification from the Centers of Medicare and Medicaid Services (CMS) or the state contractors (please see below). Please note that adjustments may be done if a policy is implemented retroactively.
    Action: If you would like to review the most current policies, please select the appropriate link below.

    Wisconsin Physician Services (Minnesota & Wisconsin) - WPS Medicare Part B
    TriCenturion (Minnesota & Wisconsin DME) - TriCenturion (DME)
    Noridian Administrative Services, LLC (North Dakota & South Dakota) - Noridian Administrative Services, LLC Part B
    Electronic Data Systems Corp (North Dakota & South Dakota DME) - Electronic Data Systems Corp (DME)
    CMS National Coverage Decision Database - Centers for Medicare & Medicaid Services (NCD Database)
    Product Impacted: Medica Prime Solution, group numbers 70200-70299 and 70500-70599
    Updated: 10/20/2006
    Date:     7/20/2006
    Description: FDA Approves New Vaccine to Reduce Risk of Shingles
    Alert: On May 25, 2006, the Food and Drug Administration (FDA) approved Zostavax, a new vaccine for the prevention of herpes zoster (shingles) in people 60 years of age and older, who are not immunocompromised.

    Zostavax, an attenuated live virus vaccine, is given as a single injection under the skin, preferably in the upper arm.

    Effective May 25, 2006, CPT code 90736 Zoster (shingles) vaccine, live, f