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Jurisdiction 11 Part A
Reprocessing Claims to Comply with the Patient Protection and Affordable Care Act

Situation
On February 4, 2011, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 7011, 'Reprocessing Claims to Comply with the Patient Protection and Affordable Care Act (ACA).' This CR addressed claims reprocessing requirements for claims affected by the retroactive nature of various provisions of the Affordable Care Act as well as retroactive corrections to the 2010 Medicare Physician Fee Schedule (MPFS). Since that time, CMS issued instructions to the Medicare Administrative Contractors (MAC) to support the reprocessing efforts.

Impact To Provider
Claims not previously edited for the CR 7011 mass adjustment of claims are currently being processed.

Status
8/26/14 – Palmetto GBA will complete processing these claim adjustments by 9/8/14.

5/5/14 - Palmetto GBA continues to process claim adjustments related to this issue.

4/18/14 – Palmetto GBA continues to process claim adjustments related to this issue.

4/9/14 - Palmetto GBA received CWF direction and is continuing to process claim adjustments.

1/24/14 - Palmetto GBA and CMS are currently working to resolve this issue.

1/17/14 – Palmetto GBA is working with the FISS Maintainer to resolve this issue. Upon resolution, the affected claims will be reprocessed.

12/19/13 - Claims containing services with frequency limitations denied, rejected or returned in error will be reprocessed.  However, if the affected claim received reason code 70034, please follow regular process for Medicare Coverage Exclusion Claims.

12/10/13 –Reprocessed claims that reject for reason code 70034 will need to follow the regular process for addressing Medicare Coverage Exclusion Claims.

11/12/13 – Claims containing services with frequency limitations are being denied, rejected or returned in error. These affected claims will be reprocessed. No provider action is required.

10/17/13 - Claims containing services with frequency limitations are RTPing in error. These affected claims will be reprocessed. No provider action is required.

10/3/13 – Palmetto GBA has completed the CR 7011 mass adjustment of claims.

9/9/13 - In the Remarks field of the xxI type of bill (TOB), it will indicate CR7011… to identify affected claims. Please note that other edits will apply to these adjustments. If you receive a Return to Provider (RTP) claim; please correct the claim and return it (F9) to continue processing.


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last updated on 08/26/2014
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