States Applicable to Alert: Hawaii, Nevada, Guam, American Samoa, the Northern Mariana Islands, Northern and Southern California
Background Information:
The file provided by CMS for January 2009, indicated the wrong status indicator for several PQRI codes. Therefore, CMS issued a joint signature memo alerting carriers to manually correct the file. Applicable codes and the correct status indicator are shown below:
| 0529F M |
4148F M |
| 0540F M |
4149F M |
| 0575F I |
4192F M |
| 1170F M |
4193F M |
| 3016F M |
4194F M |
| 3250F M |
4195F M |
| 3455F M |
4196F M |
| 3470F M |
4267F M |
| 3471F M |
4270F I |
| 3472F M |
4271F I |
| 3475F M |
4279F I |
| 3476F M |
4280F I |
| 3570F M |
|
The correction was completed with the February 24, 2009, claims cycle by Palmetto GBA.
Applicable Codes: See above.
MAC Action: Palmetto GBA made corrections to the file provided by CMS on February 24, 2009.
Provider Action: In order for the PQRI codes (M Status Codes) to report to CMS, all measure-specific coding must be on the same claim. If the applicable codes (M-Status) above were billed and they were separated from the mother ICN, the following steps must be completed:
-
Complete a written re-opening form
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Indicate on the form the reason as PQRI codes need to be added to the mother ICN and reprocessed. PQRI codes were denied and should be allowed
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Attach the EOB and clearly indicate the claims that are applicable. Mark these claims on the EOB with an asterisk (*) or an X
-
Fax the form with attachments to Express Adjustments at (803) 462-3914
Date Reported: March 31, 2009
Date Resolved: March 31, 2009