States Applicable to Alert: American Samoa, Guam, Hawaii, Nevada, Northern Mariana Islands, Northern California and Southern California
Background Information: Due to duplication in the following Hemophilia Clotting Factors furnishing fees, an incorrect pricing file was created. As a result, overpayment occured for claims processed on and after January 1, 2009, with dates of service January 1, 2006 through March 31, 2009.
January 1, 2006 - December 31, 2006: furnishing fee of $0.146 per I.U
January 1, 2007 - December 31, 2007: furnishing fee of $0.152 per I.U
January 1, 2008 - December 31, 2008: furnishing fee of $0.158 per I.U
January 1, 2009 - March 31, 2009: furnishing fee of $0.164 per I.U
Applies To Procedure Code(s): J7186, J7187, J7188, J7190, J7191, J7192, J7193, J7194, J7195 and J7198
MAC Action: A mass adjustment was performed and completed on June 11, 2009, with one claim adjusted for American Samoa, Guam, Hawaii, Nevada, Northern Mariana Islands, 82 claims adjusted for Southern California and 483 claims adjusted for Northern California.
This adjustment was for services processed on and after January 1, 2009, for dates of service January 1,2006 through March 31, 2009.
Provider Action: None
Date Reported: April 14, 2009
Date Resolved: June 11, 2009