Latest News
Medicaid/Marketplace and Marketplace Policy Updates effective January 1, 2022
Policy Number |
Policy Name |
Policy Description |
Lines of Business |
CC.PP.071 |
Evaluation and Management Services Billed with Treatment Rooms |
Disallows E&M services in treatment rooms as this does not represent a treatment type of service. |
Marketplace |
CP.MP.209 |
Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing |
Restricts reimbursement of GI pathogen panels with 12+ targets to only inpatient settings, including inpatient, ED, and outpatient hospitals. |
Medicaid, Marketplace |
Policy Number |
Policy Name |
Policy Description |
Lines of Business |
N/A |
Cotiviti 8 |
The purpose of this policy is to serve as a reference guide for general coding and claims editing information. Cotiviti 8 is a correct coding edit of ICD-10 diagnosis codes. Source: ICD-10 CM Diagnosis Code Manual |
Medicaid Medicare Marketplace |
N/A |
WCG Integration Value Capture - Correct Coding Batch 2 (Cotiviti 8) |
The purpose of this policy is to serve as a reference guide for general coding and claims editing information. Cotiviti 8 is a correct coding edit of ICD-10 diagnosis codes. Source: ICD-10 CM Diagnosis Code Manual |
Medicaid Medicare Marketplace |
N/A |
Procedure Modifier Revenue Necessary (PMRN) - Correct Coding Batch #3 |
The PMRN edit will deny procedures that require an associated modifier and also identify situations where a correct modifier and revenue code are required. The edit applies to both professional (HCFA) and outpatient facility (UB-04) claims. |
Medicaid Medicare Marketplace |
New 'Hospital Acquired Conditions' Policy - Effective January 1, 2022
Buckeye continually reviews and updates our payment and utilization policies to ensure that they comply with industry standards, while delivering the best patient experience to our members. We want to inform you of a new policy Buckeye Community Health Plan will be implementing effective January 1, 2022.
Beginning January 1, 2022, Buckeye Community Health Plan’s adjudication of claims that include Hospital Acquired Conditions will follow current industry practice and align with CMS guidelines.
Upon implementation, Buckeye may deny or reduce reimbursement for claims that include these conditions in accordance with current CMS regulations. You can see the full policy details on CMS. Note: the CMS policy is subject to update and change.
OH Enhanced (NCDs) Guidelines Claims Xten Provider Notification
Buckeye Community Health Plan is committed to continuously improving its claims review and payment processes. Effective 10/01/2021, for Medicare, we will enhance several correct coding edits based on industry standards and coding rules.
OH Correct Coding Guidelines Flexible Prov Matching Provider Notification
Buckeye Community Health Plan is committed to continuously improving its claims review and payment processes. Effective 10/01/2021 for Medicaid, Marketplace and Medicare lines of business, we will enhance several correct coding edits based on industry standards and coding rules.