Effective Immediately
In preparation for compliance with the Health Insurance Portability and Accountability
Act (HIPAA), UniCare no longer accepts local codes from providers if there is an
equivalent HCPCS (Health Care Financing Administration Common Procedure Coding System)
code or CPT (Current Procedural Terminology) code.
Listed below are some of the local codes that have been mapped to valid CPT/HCPCS codes
for Community Health Centers:
|
OLD CODE
|
NEW CODE
|
X5582
|
99050
|
X5583
|
99054
|
X5901
|
T1015-TH
|
X5902
|
T1015
|
X5903
|
90899
|
X5904
|
T1015-HQ
|
Local use modifiers (i.e. EP/Y3) and anesthesia modifier 30 are no longer valid modifiers.
Anesthesia services should be submitted with a valid ASA code.
Effective 4/30/03 HIPAA standard denial reason codes are used on UniCare's
Provider Remittance Advices (RA's). Below is a listing of the CMSP denial
codes, the old description and the new HIPAA compliant description.
|
CODE
|
OLD DESCRIPTION
|
HIPAA DESCRIPTION
|
|
ALNON
|
Non Contracted Provider Allowance
|
Contractual adjustment
|
|
DNFYC
|
Denied, Fiscal Year Closed and No Funding is Available
|
Non-covered charge(s)
|
|
EXPLN
|
Plan Exclusion
|
Non-covered charge(s).
|
|
LM200
|
Plan Limit of $200 Per Year
|
Benefit maximum has been reached
|
|
LMH20
|
Plan Limit of 20 Visits Per Year
|
Benefit maximum has been reached
|
|
LM300
|
Plan Limit of $300 Per Year
|
Benefit maximum has been reached
|
|
DNMBH
|
Claim needs to be billed through Magellan
|
Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
|
|
DNPOS
|
Denied, Incorrect or Missing Place of Service
|
The Procedure code/bill type is inconsistent with the place of service.
|
|
DNTIM
|
Services submitted exceed the filing limit
|
The time limit for filing has expired.
|
|
DNEOB
|
EOB From Other Carrier Required for Payment Consideration
|
Claim/service lacks information which is needed for adjudication.
|
For additional information please refer to the following website: www.cms.hhs.gov/hipaa
|
